What are the other Names for this Condition? (Also known as/Synonyms)

• Big Toe Sprain
• Metatarsophalangeal Joint Sprain of Big Toe
• MTP Joint Sprain of Big Toe

What is Turf Toe? (Definition/Background Information)

• Turf Toe is a common injury characterized as a sprain of the big toe joint (the metatarsophalangeal joint). It typically occurs when the big toe joint is forcibly bent upward. This can result in jamming of the toe
• The big toe consists of two joints. The larger of the two joints is the metatarsophalangeal joint or MTP joint in which the first long bone of the foot (metatarsal) connects to the first bone of the toe (phalanx).
• The MTP joint is surrounded by vital structures that hold it in place to prevent it from dislocating. The structures surrounding this joint is known as the plantar complex
• Turf Toe may be the result of a repetitive injury that occurs with regular running or jumping. And, athletic participants of a variety of sports are known to sustain Turf Toe injuries
• This type of injury is often reported in American football players; nevertheless, individuals who participate in soccer, basketball, gymnastics, and even dance, may have an increased risk of Turf Toe
• The treatment of Turf Toe usually consists of conservative methods such as rest, ice, compression, and elevation (termed as ‘RICE’). If the injury is treated early and appropriately, then the prognosis is usually excellent

Who gets Turf Toe? (Age and Sex Distribution)

• Turf Toe may occur in individuals of all ages, races, and ethnic groups
• Both males and females can be affected
• Overall, athletes who participate in certain sports, have a higher rate of injury incidence

What are the Risk Factors for Turf Toe? (Predisposing Factors)

Common risk factors of Turf Toe include:

• Individuals who participate in sports that involve competing on artificial turf surfaces: The sports may include American football, soccer, basketball, cricket, wrestling, gymnastics, lacrosse, and dance
• Increased friction between the shoe and sports surface
• Wearing shoes with flexible soles
• Poor coordination while playing certain sports can increase the risk for Turf Toe
• Increased dorsiflexion of the foot: Dorsiflexion refers to a state when the dorsum of the foot rotates upwards towards the shin/leg. Such movement increases pressure on the big toe causing Turf Toe
• Poor quality of artificial turf (reducing its force-absorption capacity)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Turf Toe? (Etiology)

Turf Toe occurs when the ligaments and joints structures around the big toe are damaged due to excess or disproportionate (undue) force on it. This may occur while:

• Participating in any sport that involves an artificial turf, such as American football, soccer, basketball, wrestling, gymnastics, lacrosse, or dance
• These sports usually involve sudden directional changes, which can cause the big toe to slide to the end of the shoe

What are the Signs and Symptoms of Turf Toe?

The severity of the signs and symptoms of Turf Toe depends upon the extent of the damage. The common signs and symptoms of the injury may include:

• Pain and tenderness in the ball of the foot and the big toe; swelling and bruising in the same region
• Difficulty walking or pushing-off the big toe (while taking a step)
• Decreased range of motion of the big toe
• Prolonged pain and stiffness in the big toe, which makes it difficult to walk, stand, or climb stairs

Physicians categorize Turf Toe into 3 grades, based on the severity of injury sustained, which can help determine the suitable treatment to be provided.

• Grade 1 Turf Toe: This occurs when the structures surrounding the metatarsophalangeal joint (plantar complex) is stretched, causing tenderness and pain
• Grade 2 Turf Toe: It is characterized by the partial tearing of the plantar complex, which causes tenderness, swelling, and bruising. An individual’s range of motion in the toe is restricted and the injury is painful
• Grade 3 Turf Toe: It is characterized by a complete tearing of the plantar complex, which causes severe tenderness, severe swelling, and bruising. It is very difficult and painful to move the big toe, since the injury is severe

How is Turf Toe Diagnosed?

Diagnostic methods that a healthcare provider may use to help diagnose Turf Toe include:

• Physical examination: A physician can usually diagnose Turf Toe after performing a thorough physical examination of the big toe. During this exam, a physician will examine the foot for swelling, bruising, and test the range of motion in the MTP joint. The healthcare provider will move the big toe up and down, and side to side, looking for any evidence that may suggest a tear of the plantar complex. In some cases, a medication may be injected to reduce pain before testing the range of motion in the big toe. In addition to this, a complete medical history (circumstances that led to the injury) will aid in arriving at a definitive diagnosis
• X-ray of the affected foot: X-rays use radiation to produce images of the affected region (big toe). It can help the healthcare provider rule out other possible causes of discomfort, such as a fracture
• Magnetic resonance imaging (MRI) of the foot: An MRI scan is a more detailed scan that uses radio waves and strong magnetic fields to produce clearer images of injuries to the soft tissue and cartilage in the foot. An MRI scan is helpful for Grade 2 and Grade 3 Turf Toe injuries, or when certain abnormalities are found on an x-ray image

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Turf Toe?

The common complications of Turf Toe may include:

• Prolonged pain and stiffness of the big toe, especially while running
• Bunions of the big toe
• Hallux rigidus (a type of joint disorder)
• Arthrofibrosis

Severe complications of Turf Toe may develop such as:

• Infection of the big toe
• Hypertrophic scar formation
• Development of plantar nerve neuroma

How is Turf Toe Treated?

Conservative, nonsurgical methods usually form the first line of treatment for Turf Toe injuries. The RICE method is effective for a high percentage of sports-related injuries including Turf Toe. RICE is an acronym for Rest, Ice, Compression, and Elevation.

• Rest: Any activity that aggravates the foot condition further should be avoided. The healthcare provider usually advises individuals to refrain from such activities, until the symptoms improve
• Applying ice to the foot can help with pain, reduce inflammation, and control the symptoms
• Wearing an elastic compression bandage can help stop additional swelling, and move fluids out of the area
• Individuals may be advised to wear a metatarsal pad to help cushion the area underneath the toe
• Elevation: Elevating the hamstring helps to decrease swelling and prevent fluid buildup
• In more severe cases of Turf Toe, a walking boot or cast may be needed
• Non-steroidal anti-inflammatory oral medications, such as ibuprofen, may be used to treat Turf Toe. These medications can help decrease pain and swelling

If the symptoms of Turf Toe continue to persist, surgery may be needed. Healthcare providers usually recommend surgery for severe grade 3 Turf Toe injuries.

How can Turf Toe be Prevented?

In most cases, Turf Toe injuries cannot be prevented. However, wearing appropriate shoes and using the correct techniques while participating in sports, can help reduce the risk of developing Turf Toe.

What is the Prognosis of Turf Toe? (Outcomes/Resolutions)

• The prognosis of Turf Toe is usually good in a majority of individuals
• A proper and early treatment of Turf Toe can also usually prevent the development of any long-term complications.
• Individuals who experience prolonged and persistent pain, surgery may be needed to address the condition

Additional and Relevant Useful Information for Turf Toe:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/