The toes consist of multiple osseous and soft tissues including tendons, nerves, and ligaments, that support our body weight. Each toe has several small bones called phalanges that connect to metatarsals, the longest bones in our midfoot.
Each toe is made up of three phalanx bones, which are the proximal, middle, and distal, except for the big toe which only has two phalanges, the proximal and distal. The primary function of your toes is to provide posture and balance, support the body weight, and propulsion during the gait cycle.
Not only do your toes help thrust your body forward when you walk, they actually help increase the length of your stride allowing you to run faster. Additionally, there are a total of two joints in the big toe. These joints allow the toe to flex downward and extend upward. The big toe generally plays a role in the ability to walk and run.
When the foot touches the ground and prepares to take another step, the big toe is the very last joint through which the foot pushes off the ground to move the body forward. The main joint involved in this specific motion is the metatarsophalangeal (MTP) joint.
A turf toe is a sprain to the MTP joint. When the MTP joint is suddenly injured or sprained, it can lead to varying degrees of pain, bruising, swelling, and sensitivity right below the joint or at the ball of the foot.
This type of injury occurs when the big toe over-extends, injuring the soft tissue in the plantar complex. While turf toe is prevalent among athletes playing on artificial surfaces, this injury especially impacts certain sports activities, such as basketball, soccer, American football, and lacrosse players, as well as dancers.
Causes & Symptoms of Turf Toe
An injury to the big toe occurs when the big toe is suddenly bent at a 90-degree angle and pressed flat against the ground. Normally, the heel is high off the ground, similar to a sprinter’s starting position.
If you place an intense amount of force on the big toe, you can bend it farther than it is supposed to go (hyperextension). Therefore, bending the toe beyond its natural range of motion may cause ligaments, tendons, and soft tissues in the joint to stretch or tear. Moreover, turf toe can result from several repetitive movements over time (such as jumps from a ballet dancer).
The injury may also result from sudden trauma, such as when a wrestler tackles an opponent whose toe is planted on the ground. Athletes who take sudden foot movements and changes in direction are more susceptible to experiencing this type of injury.
Turf toe can occur in three different severity grades, such as the following:
Grade 1 turf toe
The first grade of turf toe is considered a minor injury involving a stretched plantar complex, with possible tenderness and swelling. It is required to take the time to rest from athletic participation to recover from the injury.
Failing to rest the MTP joint can make the injury worse, thus leading to grade 2 of turf toe. Recovery from a grade 1 turf toe may take a few days to a week.
Grade 2 turf toe
A grade 2 turf toe causes moderate pain, diffuse tenderness, bruising, and visible swelling due to a partial tear in the plantar complex. Your daily activities are disrupted with a limited range of motion which may lead you to symptoms like limping when weight is applied to the foot. Medical care is usually advised to ensure the injury is not serious and to guide physiotherapy treatment. Second-graded turf toe injuries may take a few weeks to fully recover with conservative treatment.
Grade 3 turf toe
A grade 3 turf toe is a result of a complete rupture of the plantar complex. Severe pain is accompanied by acute swelling, bruising, and tenderness. You will also be incapable of applying any weight to the big toe. Urgent medical care is recommended with several weeks of immobilization to heal the injured big toe.
Other symptoms that are commonly associated with all grades of turf toe include:
- Black and blue discoloration.
- Pain upon touch.
- Limited big toe motion.
- A sensation that your joint feels loose.
Who gets Turf Toe?
Anyone can develop turf toe, however, other certain risk factors for developing the condition include the following:
Turf toe is very common in sports for athletes who participate in sports activities, especially from basketball, soccer, American football, wrestling, hockey, dance, and lacrosse. Ultimately, turf toe may occur during any activity where the front of the foot is planted on the ground and the heel is lifted.
Most shoes tend to become increasingly flexible and lightweight and provide little support at the front of the foot. This can increase the chance of injuring the big toe. Many athletes are oftentimes required to wear stiff-soled shoes, such as cleats instead of tennis shoes, to avoid turf toe injuries.
Patients ages older than 50 years are prone to injuring their big toe due to general wear and tear (degeneration).
How Does Turf Toe Affect You? How Serious is it?
If turf toe is left untreated, you could experience longer-term stiffness and extreme pain in your toe joint, which may require surgical treatment if pain persists. Surgery is often not necessary for treating turf toe.
However, if your symptoms persist or your level of athletic play is drastically affected, surgery may be an option. The surgical procedure will normally vary according to the severity of the injury. The ultimate aim of surgery is to repair the soft tissues and restore the MTP joint motion to preserve regular function.
All surgeries require incisions (cuts that allow surgeons to open an area of the body and make repairs). This therefore means there is a chance of complications, but with a low percentage of it happening – some of these complications include:
- Persistent toe pain – Some patients tend to continue to have persistent toe pain after surgery.
- Nerve or blood vessel damage – During surgery, there is a slight chance that the nerves, veins, or tissue around your toe can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the toe.
- Blood clots – Because surgery affects the way blood flows around your toe, it can increase your risk of developing blood clots.
Recommended Treatment & Rehabilitation for Turf Toe
Normally, a clinical evaluation, medical history, and physical examination are enough to detect turf toe. Imaging may also be used to verify the diagnosis, rule out additional injuries, and gauge the intensity of the sprain. Some of these imaging tests may include:
X-rays may be ordered to rule out bone-related issues, such as a fracture. It is highly recommended to have radiographs taken, along with central images of sesamoids, or small bones in the foot. Your doctor may take comparison X-rays of the opposite foot to ensure the sesamoids are correctly located.
Magnetic Resonance Imaging (MRI)
An MRI provides clear images of non-bone structures, such as the tissue, ligaments, and tendon encompassing the MTP joint. This imaging is greatly beneficial for patients with grade 2 or 3 turf toe injuries, or those with deformities found in X-rays.
The following below are usual treatment options with the use of supporting equipment depending on the severity of your turf toe injury:
- Grade 1 – Taping or inserts may be used to restrict painful motion. In several cases, you may return to your regular activities within a few weeks.
- Grade 2 – A brace or walking boot may be prescribed for several weeks to restrict movement and allow rest.
- Grade 3 – Surgery may be needed for a grade 3 injury. Your doctor will determine whether you need surgery based on the severity of the damage and its impact on your function.
Once a diagnosis is done, physiotherapy may be further advised. With any grade of a turf toe injury, a physiotherapist will work with you by designing a special treatment plan specific to your condition and goals. Some treatment plans may include:
It is very important to regain the full range of motion of your big toe and foot. If your injury required the use of a brace or boot to restrict movement during healing, your toe and foot joints may be stiff. Your physiotherapist will teach you gentle stretching and movement exercises, including guided toe exercises, to help restore regular movement.
It is common to lose strength in the muscles of your foot, ankle, and leg after a toe injury. This is due to the change in activity and any bracing or boot used to restrict movement during healing. Your therapist will determine which muscles are weak and teach you specific exercises to strengthen them.
Manual therapy can be especially effective to restore movement in joints that become stiff after being immobilized. Your physiotherapist may gently move the joints involving your injury for you. This might feel like your foot is being gently wiggled.
Your physiotherapist will likely educate you to help make sure that you fully recover from your turf toe injury. He or she will identify any activities you should avoid or limit at certain stages in your recovery.
Below are a few exercise examples for you to try at home in order to restore regular movement from mild hammer toe symptoms:
- Toe curl – Sit on the floor, with the heel of your affected foot on the floor. Next, gently curl your toes forward and then backward. Hold each position for about 6 seconds. Repeat 8-12 times a day.
- Towel scrunches – Sit in a chair and place your affected foot on a towel on the floor. Then, scrunch the towel toward you with your toes then use your toes to push the towel back into place. Repeat 8-12 times a day.
- Marble pick-ups – Put some marbles on the floor to lift up one marble from the floor at a time. Then try to put the marble in the cup. Repeat this method 8-12 times a day.
- Towel stretch – Sit with your legs extended and knees straight. Next, place a towel or belt around your foot just under your toes. Hold both ends of the towel or belt, with your hands above your knees. Pull back with the towel or belt so that your foot stretches toward you. Hold the position for at least 15-30 seconds, then repeat 2-4 times a day.
Alternative & Homeopathic Treatment for Turf Toe
There are many different ways to ease your toes homeopathically after being treated. Some of these alternative treatments include:
- Non-steroidal anti-inflammatory medications (NSAIDs) – Taking anti-inflammatory medications can help alleviate your pain.
- Padding – Padding around the injured toe can minimize pressure.
- Fish oil – Omega-3 oils are perfect for supporting nerve health and preventing foot pain.
- Massages – Having a foot massage by a massage therapist can help seek out tender spots in your affected toe and other areas in your feet and press on them while gently stretching.
- RICE method – RICE stands for rest, ice, compression, and elevation. Many athletes tend to follow this method in order to rule out further symptoms linked to turf toe.
- Foot shower – Patients can bathe sore, painful, or tired feet in a bowl of warm water. Some individuals find that Epsom salts in the water can help ease the soreness much further.