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 What is it? Turf toe is foot injury that affects athletes in many sports and activities. The injury occurs on the bottom of the foot at the joint (metatarsal phalangeal joint, or MTP joint) where the big (first) toe meets the foot. At the bottom of the joint there are a complex of tissues (ligament, sesamoid bones, and joint capsule) called the plantar plate that can get stretched (sprain) by forced flexing of the toe up resulting in Turf Toe. The injury can occur by a forceful strike against the ground, or a fellow player. Risk factors can be artificial turf surfaces, and flexible soft shoes.
Symptoms/Risks • Swelling at the big toe and joint • Tenderness of the joint, mostly the underside of the joint (plantar surface) • Bruising • Pain with bending the toe up and down (flexion and extension), therefore affecting the ability to walk and push off
Sports Medicine Evaluation & Treatment When seen by a sports medicine provider, a history of the injury will be taken and physical exam will be done. The provider will feel for tenderness, test the range of flexion and extension of the joint, and test the strength of the joint. The stability of the affected joint will be tested by sliding the two bones (base of the great toe and the top of the long bone in the foot) along each other and assessing for degree of looseness of the joint. Additionally, imaging may be considered, including x-rays, ultrasound and perhaps even MRI or a bone scan. The severity of the injury can be graded as such: Grade 1 - sprain of the plantar plate. Grade 2 - partial tear of the plantar plate. Grade 3 - complete tear of the plantar plate. Treatment of the sprain is determined by the severity of the injury or grade. Grade 1 - usually can be managed with icing and short rest, followed by taping to the next toe and placing a rigid shoe insert under the first MPT joint. Grade 2 - a period of rest for approximately 2 weeks in a hard-soled shoe or boot, followed by taping and rigid insert. Crutches may be used if to avoid putting weight on the injured foot if there is still pain with walking. Grade 3 - consider referral to a foot and ankle orthopedic specialist. Generally, should consider putting the patient in a boot or short-leg cast for 2-6 weeks. About 2% of these injuries may need surgery.
Injury Prevention One can try to prevent turf toe by increasing awareness of higher risk individuals (i.e running backs, quarterbacks, those wearing flexible soft shoes, those playing on artificial turf surfaces). Appropriate shoe wear for the sport should be used.
Return to Play Grade 1 - sprains may return to play can occur once the patient has near full strength and range of motion at the injured toe. Grade 2 - sprains can be rested for about 2 weeks with the above treatment recommendations and then return as able. Grade 3 - sprains may take up to 3-4 months, but it varies based on treatment. AMSSM Member Authors References Category: Foot and Ankle, Trauma, [Back] |
