Turf Toe is a name used to describe sprains in the big toe. Usually, these sprains are caused by forces stretching the tendons running underneath the toe (‘dorsiflexion’).
Symptoms
The pain of turf toe is felt at the base of the big toe, on the underside of the foot. The signs and symptoms include:
- Pain and tenderness under the big toe joint
- Swelling and bruising around the joint
- Pain on pushing off, making walking and running difficult
- A big toe that will not bend as far as normal
- A feeling that the toe is loose, in more severe sprains
The pain may come on suddenly during sport, or build up over several days of hard training.
Causes
Turf toe happens when the big toe is bent too far upwards, overstretching the tissues underneath the joint. Sometimes this occurs in a single movement, such as pushing off hard or being tackled while the foot is planted. In other cases it builds up over weeks of repeated loading.
The injury takes its name from the move to artificial turf in sport. Hard surfaces and flexible shoes allow the toe to bend further than it should.
Risk Factors
Turf toe is most common in sport played on hard or artificial surfaces, particularly the football codes. Other things that increase the risk are:
- Shoes with a soft, bendy sole
- A previous turf toe injury
- Reduced movement or stiffness in the big toe
- Greater body weight, which loads the toe more on push off
Investigations
Your doctor can usually tell what has happened by examining the toe and asking how the injury occurred. Tests that may be used include:
- X-ray, to check that no bone is broken and the toe is not out of joint
- MRI, for a severe sprain or a toe that is not improving as expected
Complications
Most people recover fully, but problems that can follow a severe sprain include:
- Pain that carries on for months
- A stiff big toe that will not bend as far as before
- Arthritis in the big toe in later years
- Pain elsewhere in the foot, from changing the way you walk to protect the toe
- An inability to return to the same level of sport, after the most severe injuries
Treatment
Most turf toe recovers without surgery. Treatment includes:
- Rest, ice, compression and elevation in the first few days
- Taping the toe to stop it bending too far
- A stiff-soled shoe or a carbon plate in the shoe, which stops the toe bending at the painful point
- A walking boot or plaster for a few weeks, for a more severe sprain
- Simple pain relief and anti-inflammatory medication
- Physiotherapy to restore movement and strength before returning to sport
The stiff sole is the single most useful measure for getting back to sport, because it protects the joint through the movement that hurts. Surgery is rarely needed, and is reserved for tissues that are badly torn, a piece of bone that has pulled off, or a toe that remains unstable.
Prevention
The risk of turf toe can be reduced by:
- Wearing shoes with a firmer sole for sport on hard surfaces
- Building up training gradually rather than in one jump
- Taping the toe or using a stiff insole if you have injured it before
Getting a turf toe injury properly treated the first time matters. Returning to sport too early is the main reason it becomes a long-term problem.