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Orthocarolina discusses toe turf treatment options

Chris Gabriel, OCS, CSCS

What Is a Toe of Turf?

Turf toe, the largest joint in the big toe, which connects the first bone in the toe and the first long bone in the foot, is a sprain to the metatarsophalangeal joint (MTP). It may lead to varying degrees of discomfort, bruising, swelling, and sensitivity below the joint or at the ball of the foot when the MTP joint is damaged or sprained.

A plantar complex consisting of tissue, ligaments, tendons, and small bones is protected and secured by the MTP, and the other joint of the big toe is called the proximal interphalangeal joint (PIPJ). Turf toe happens when the big toe over-extends and damages the soft tissue in the plantar complex.

Turf toe got its name from America football. Artificial turf on many football pitches has become more common than real grass because it's cheaper to maintain. With turf, there is no soil underneath, which makes it firmer than grass. However, the turf can be more slippery than grass in rain or snow.

For this reason, football players slip and hurt their toes or get injured when their feet slam down on the turf. Moreover, ballet dancers, basketball players, and wrestlers can also get a turf toe because they use their feet on hard surfaces.

This injury is a type of joint sprain of the metatarsophalangeal (MTP). This implies that it has injured the tissue and one or more of the joints that connect the toes to the rest of the foot.

Read on to learn how the turf toe can be treated.

What Are the Symptoms of Turf Toe MTP Joint Injury?

Pain around the large toe area, including the joint that goes up your foot toward your ankle, is the most notable turf toe symptom. If your toe bends suddenly and quickly, you might feel the pain right away.

If you have hyperextended your toe over and over, the pain can start coming on gradually. When you first bend the toe too far and feel the pain, you may also notice a popping sound.

Additional symptoms include:

  • Sensitivity or tenderness around the toe and nearby joints
  • Not being able to move the toe around normally
  • Rigidity in the joint of the toe

How is Turf Toe Caused?

The turf toe is a sprain in the ligaments around the large toe joint, which mainly acts as a hinge to allow movement up or down. There are two pea-shaped bones in the tendon right behind the big toes in the ball of your foot that move your big toe, called sesamoids. These bones function like a tendon pulley and give leverage. As you walk or run, they absorb the weight that presses on the ball of your foot.

  • Sesamoids: Two small bones that help the front of your foot absorb the weight.
  • Flexor Hallucis Brevis: A tendon that helps the big toe when running or jumping with your weight on it.
  • Collateral Ligaments: Tissue bands that link the bones of the toe and keep the large toe from bending more on either side of the leg.
  • Plantar Plate: A framework that prevents your big toe from bending too far up.

When you walk or run, you begin by raising the heel forward every step and let your body weight move on the ball of the feet. At one point, you push yourself forward by pushing your big toe away and enabling your weight to move to the other foot. If the toe stays on the ground for some reason and does not lift and push out, the area around the joint is in danger of sudden injury.

The injury is unexpected, with a turf toe. It is most often seen in athletes playing on artificial surfaces that are tougher than grass surfaces and to which cleats are more likely to stick. It can also happen on a grass surface, especially if the shoe being worn does not provide sufficient foot support. The accident also happens with athletes wearing flexible football-style shoes that cause the foot to bend too far forward.

How Do Doctors Diagnose Turf Toe?

Talk to your doctor about the situation in which you think you suffered the injury first. This helps your doctor know that any pain, swelling, or other abnormalities may indicate that turf toe is the cause of toe pain and stiffness may be examined in your big toe. To check your overall health, your doctor may also do a full physical examination.

Any abnormal swelling or redness will be looked for by your doctor. They will also push your toe to see where the pain comes from and move the toe around to test your toe's range of motion. Let your doctor know if this causes a lot of pain. They may be able to inject your toe with a substance to numb it.

To look more closely at the tissues and bones around the toe, your doctor might also recommend imaging tests. The two most common tests are:

  • X-ray, which allows your doctor to check for anomalies by seeing the bone structure around your toe.
  • MRI scan to help your doctor see a clear image of the area around your foot.

How To Treat Turf Toe Injuries?

Three grades of turf toe injuries occur. The treatment will depend on the grade of the injury.

Grade 1 Turf Toe Treatment Options

Grade 1 injuries can be treated at home, the least serious of the three, using the RICE method:

  • Rest
  • Ice
  • Compression
  • Elevation

Rest: Stop doing tasks that can make the injury worse and give yourself a break for the toe to heal the sprain.

Ice: To keep swelling and inflammation down, apply a cold pack or ice in a plastic bag to the area.

Compression: Wrap the foot and the toes with a bandage. It keeps the big toe from moving more and making the injury worse.

Elevation: Lie down with your feet up to help drain fluid and keep swelling down.

You can help manage your pain until the injury heals by taking nonsteroidal anti-inflammatory drugs (NSAIDs). To help keep you from bending your toe, wear shoes that do not bend easily and quickly.

Grade 2 Injury on the Metatarsophalangeal Joint

Injuries in Grade 2 are a little more severe and may require you to use crutches or a walking boot while the injury heals to protect your foot.

Grade 3 Injuries

To treat a Grade 3 injury, you may undergo surgery because a bone is broken, a ligament is completely torn, or the joint is weakened.

The type of surgery you need depends on what section of your plantar complex needs care. Your doctor can use sutures to fix the soft tissue, such as a ligament or a joint capsule, if damaged.

Sutures are body tissue stitches. If a bone is fractured, the bone will need to be healing. To protect the toe until it completely heals, you may need to wear a cast.

The Recovery Period of Your Toe May Take

A few days to a week, you will normally heal from a Grade 1 injury.

Injuries in Grade 2, typically take a few weeks to heal fully. Following a Grade 2 injury for two or more weeks, you will not be permitted to play sports or do any exercise.

Injuries in Grade 3 will take months to heal. Before the doctor encourages you to play sports or exercise again, you will need to wear a cast for six or more weeks and have multiple follow-up appointments.

Prevention of Toe Turf MTP Joint Injuries on Your Big Toe Joint

Preventive steps may be taken to reduce the risk of a recurring turf toe injury. The measures that they should take depend on the development of the injury. 

The use of better-supporting shoes will help to prevent the toe from bending too far when a person pushes out. 

You may also wear inserts in your shoes to keep your toe supported.. 

A sports or physical therapist may work with a patient to address any concerns with how they walk and run. This may help them learn new fitness or sports techniques that will help stop recurrent turf toe injuries.

Recovery Outlook on Treatment for Turf Toe Injury

Turf toe wounds can affect your ability to walk, run, and play sports without diagnosis and treatment. Early intervention leads to most turf toe injuries being treated successfully. Athletes can recover from their turf toes and return to the health and fitness level before the injury.

Surgical treatment may be needed if the injury is serious. Severe turf toe Grade 3 might have long-term effects.

A 2018 study evaluating the outcomes of surgery in 15 competitive football players for Grade 3 turf toe injuries, found that players missed an average of 16.5 weeks of playoff experience. The study concluded that with surgical repair, positive clinical results were possible.

No surgery is required for a patient with a relatively mild turf toe injury. If anything, medication for pain management and physical therapy can help them restore the full range of toe movement, flexibility, and strength.

Turf Toe Injury Key Points

A sprain of the main joint of your big toe is a "turf toe." This is the joint of the metatarsophalangeal (MTP joint). The support structures known as your plantar complex are weakened by trauma. It happens when, as when pushing off into a run, the toe bends painfully upwards.

In sporting activities involving artificial turf, turf toes are more common.

You may have signs such as bleeding, swelling and bruising, discomfort, and the inability to range of motion from your injury to your toe.

There will be no surgery needed for most people with turf toes. Your healthcare provider may use rest ice compression, elevation, pain killers, and immobilization to treat your injury.

However, some individuals with more serious turf toe injuries may need surgery.

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