How Can You Tell If You Have Turf Toe?

Turf toe occurs in any activity when the metatarsophalangeal (MTP) joint at the base of the big toe is hyperextended.

Turf toe is a sprain of the main joint of the big toe that occurs when the big toe is forcibly bent upwards (hyperextended).

Turf toe became more common among American football players when artificial turf, which is harder than grass, came into more widespread use on football fields, giving rise to the term "turf toe." 

The sprain is graded based on severity:

• Grade I: Sprain of the plantar capsular ligament complex is painful but not disabling
• Grade II: Partial tear of the plantar capsular ligament complex
• Grade III: Sprain with severe swelling and bruising, weakness of great toe movement, and toe joint instability 

Turf toe occurs in any activity when the metatarsophalangeal (MTP) joint at the base of the big toe is hyperextended. It usually happens in sports or activities when the forefoot is set on the ground and the heel is raised, and a force pushes the big toe too far back toward the foot.

Turf toe is common among American football players who play on artificial turf, which tends to be harder and less shock absorbent than real grass. 

Basketball, ballet, wrestling, gymnastics, running, soccer, and any activity that involves putting a lot of weight on the big toe can result in turf toe. Additionally, sudden trauma such as a motor vehicle accident where a driver braces the feet against the floor can result in turf toe.

Symptoms of turf toe may include: 

• Pain
• Tenderness 
• Swelling
• Bruising
• Limited big toe movement
• Stiffness in the toe joint
• Feeling a “pop” when the injury occurs

Turf toe is diagnosed with a patient history and physical exam, along with tests such as: 

• X-rays
• Magnetic resonance imaging (MRI) scans

• Rest: avoid walking or putting weight on the injured foot
• Ice: Ice the injured area 20 minutes at a time, several times a day (do not apply ice directly to the skin)
• Compression: use an elastic compression bandage, such as an ACE wrap
• Elevation: put the leg higher than the heart to reduce swelling

Additional treatment for turf toe depends on the grade of the sprain. 

Treatment for a Grade 1 sprain includes: 

• RICE: Rest, ice, compression, and elevation
• “Buddy taping” the big toe to the smaller toes to restrict motion
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) to help relieve pain and swelling
• Orthotics to help reduce stress on the plantar plate and provide stability
• Athletes may be able to continue participation in sports wearing a stiff-soled shoe

Treatment for a Grade 2 sprain includes treatments used for grade 1 sprains and: 

• Walking boot to keep the MTP joint immobilized
• 3 to 14 days of rest before returning to play

Treatment for a Grade 3 sprain includes:

• Immobilization for several weeks in a walking boot or cast that keeps the big toe in a partially pointed down position
• As the injury heals, treatment can step down to Grade 2 and then to Grade 1
• Physical therapy to help to stretch and strengthen the big toe as soon as recovery will allow

Surgery is usually not needed to treat turf toe, and is only used for patients who have symptoms that do not go away or for athletes whose levels of play are affected. Surgery is used to repair the soft tissues and restore the MTP joint motion to preserve normal function. 

Surgery is generally reserved for serious Grade 3 injuries such as:

• Severe tear of the plantar complex
• Fracture of the sesamoid bone
• Vertical instability (unusual up and down motion) of the MTP joint
• Loose bony chip in the joint
• Damage to the cartilage of the joint
• New or worsening bunion