Turf Toe: Signs, Symptoms, & Treatment

When the big toe bends upwards too much it causes damage to the ligaments and joint capsule (as

described in the previous section), which can become stretched or torn. In turf toe, the surfaces of the

bones at the joint can become damaged as well. A joint is a place where two bones contact each other.

Tiny breaks can also occur in the big toe bone, which is discussed in more detail below.

Another cause of turf toe is when a person is standing on the front part of the feet and is pushed forward

by someone else. This can cause the toe to be extended outwards too much, leading to the same type of

damage described above. Pushing off of the front toe repeatedly while running or jumping can also

cause turf toe.

WHAT ARE THE SIGNS AND SYMPTOMS OF TURF TOE?

The signs and symptoms of turf toe include pain, restricted movement, tenderness, and swelling at the

joint (the place where two bones contact each other) of the big toe and the metatarsal bone in the foot.

There are five metatarsal bones in the foot. They are located in the center of the foot, behind the toes.

One metatarsal bone attaches to each toe. The pain in the big toe may cause the person to limp while

walking. The outside of the toe may appear red and bruised.

In mild conditions of turf toe, there will little damage to the area of bone beneath the cartilage (a type of

tissue) in the big toe. However, there will signs and symptoms of swelling inside the joint. In more severe

cases of turf toe, the signs and symptoms will be worse because there will be damage to the area of

bone beneath the cartilage, the surface of the joint, or both. These types of injuries are usually visible on

x-rays.

If turf toe is caused by repetitive actions that cause injury (such as continuously jamming the toe), the

signs and symptoms will usually begin slowly. This usually happens in younger athletes as they try to

increase their activity. The problems may not be noticeable until after the first or second athletic season,

but once the pain begins it will occur more often and be more severe, depending on the activity the

person is doing.

If turf toe is caused by a direct injury to bone beneath the cartilage or the articular cartilage, the signs

and symptoms may begin suddenly and get worse over a 24-hour period or may get worse slowly as the

season progresses. Articular cartilage is a type of tissue that covers some types of bone joints.

ARE THERE DIFFERENT TYPES OF TURF TOE?

Yes. There are three different types (or grades) of turf toe, ranging from the least severe to the most

severe. The severity depends on the type of damage to the ligaments and joint capsule. See our first

section of this entry for an explanation of ligaments and joint capsules. The types of turf toe are as

follows:

GRADE I: In this type, the ligaments and joint capsule are stretched.

GRADE II: In this type, the ligaments and joint capsule are partially torn.

GRADE III: In this type, the ligaments and joint capsule are completely torn.

As you might imagine, the more severe the injury, the longer it will take to recover.

WHO GETS TURF TOE?

Turf toe usually occurs in people who play games on fake surfaces such as fake grass. Football players

get this condition the most, especially offensive players. Of football players, running backs, wide

receivers, and linesmen are most likely to get turf toe. Baseball players, soccer players, and people who

do martial arts often get turf toe as well.

WHAT PUTS PEOPLE AT RISK FOR TURF TOE?

Playing on artificial surfaces puts people at risk for turf toe. People are more at risk for turf toe that wear

soft, flexible shoes and who have increased range of motion in the ankles. Range of motion means the

degree in which a person can move a body part. Playing positions in sports in which the ankle flexes

backwards (towards the front part of the legs) puts one at risk for turf toe. Wearing a wider and longer

shoe puts one at risk for turf toe because the big toe has more room to move around and get injured.

HOW IS TURF TOE DIAGNOSED?

Turf toe is not a difficult diagnosis to make. The first step is for the doctor to obtain an accurate patient

history. This will help determine how the injury happened. The patient usually states that a snapping

sound was heard at the time of injury. It needs to be determined that the big toe was extended too much

in an upwards direction, accompanied by pain and swelling. Depending on the severity of the injury, the

big toe may have bruises on it and decreased range of motion when examined. Range of motion means

the degree in which a person can move a body part. An x-ray of the foot is taken to make sure there are

no breaks.

Rarely, a magnetic resonance imaging (MRI) scan or a bone scan may be performed to make sure there

are not other causes for the foot pain. MRI scans produce extremely detailed pictures of the inside of the

body by using very powerful magnets and computer technology. A bone scan is a scanning technique

used to produce pictures specifically of bones.

HOW IS TURF TOE TREATED?

Doctors recommend treating turf toe in the following manner. First, the toe should immediately be iced

after it has been injured. Next, a bandage or tape should be placed around the toe that compresses

(squeezes together) the area. This helps rest the joint and reduce swelling. Heat is sometimes applied to

the toe as well to provide pain relief. Another technique used is called a contrast bath, in which a person

places the foot in hot water and then in cold water, repeating this process for a certain period of time.

Contrast baths are used in the early stages of injury.

As much rest as possible is recommended, which usually involves elevating the foot while resting.

Crutches may also be used to take pressure and weight off of the big toe. After 2 to 4 days, the person

may be able to walk without the crutches. A brace is also recommended to protect the big toe by

restricting its movement and preventing it from being injured again. If a person does not want to wear a

brace a shoe or boot should be worn that has a firm sole (bottom), which will not allow the big toe to

bend. Sometimes, a Morton's extension is used to accomplish this, which is a type of pad fitted under the

joint of the big toe.

A sports injury professional should be sought for advice. He/she can take an x-ray of the toe bone to

make sure it is not broken, tape the toe to prevent movement, and recommend a rehabilitation program.

A sports injury professional can also apply ultrasound treatment, which involves using high-frequency

sound waves to soft tissues. This technique can reduce swelling and speed up healing.

Electrotherapy, in which electricity is used to treat the tissues, is another option that a sports injury

professional can use to reduce pain and swelling. One such technique is called iontophoreisis, in which

ions (electrically charged atoms) of certain salts are introduced into the tissues by electric current. An

atom is the smallest part of a substance that can exist alone or in combination with something else.

A sports injury professional can give medications at times to decrease pain and swelling. The drugs that

are given to do this are known as NSAID's (Non Steroidal Anti-inflammatory Drugs). Corticosteroids, a

different type of medication, are usually not recommended because they have been known to weaken

the tendons (groups of fibers that attach muscles to a bone) and ligaments (see first section), and make

the patient more likely to get an infection. Corticosteroids are a group of drugs that act similarly to a

natural chemical in the body known as corticosteroid hormone. Corticosteroid hormones control the

body's use of nutrients and the amount of water and salts in the urine.

Surgery is rarely used to repair damage to the ligaments or joint capsule of the big toe joint. See our first

section of this entry for an explanation of ligaments and joint capsules. Surgery can also be done to

shorten the size of the first of two bones that make up the big toe. Surgery is reserved for severe cases

that do not respond to other treatments to repair the damaged areas. Sometimes surgery is used to

remove any bone spurs that may have formed near the big toe. A bone spur is a knobby, abnormal bone

growth.

HOW LONG DOES IT TAKE TO RECOVER FROM TURF TOE?

Depending on how bad the condition is, it can take three to four weeks to recover from turf toe. As a

general rule, the more severe the injury, the longer it will take to recover. It is important to note, however,

that it is not uncommon for the signs and symptoms of turf toe to go away during the time of the year that

the person is not playing sports, only to come back when the person starts to exercise again.

WHAT CAN BE DONE TO PREVENT TURF TOE?

Playing on natural grass helps prevent getting turf toe. Some of the recommendations in the treatment

section, such as using a brace, tape, and different types of shoes, can be used for prevention of turf toe.

WHAT IF TURF TOE IS NOT TREATED?

If turf toe is not treated, it is possible for the injury to develop into decreased range of motion due to

arthritis around the joint of the big toe. Range of motion means the degree in which a person can move a

body part. Arthritis is an inflammatory condition of the joints, which is a place where two bones contact

one another.

Many tiny breaks in the bone beneath the cartilage (a type of tissue) of the big toe can occur if this bone

continues to be squeezed together from turf toe injuries. Normally, the area of bone between the end of

the big toe and the main part of the big toe is soft and spongy. However, when turf toe becomes more

severe, this area of bone can become hard and more easily broken, a process known as eburnation.

When this happens, the articular cartilage loses its support and is more easily damaged. Articular

cartilage is a type of tissue that covers some types of bone joints.

Many conditions can develop that can cause slow, but worsening destruction of the joint. These

conditions include bone spurs (knobby, abnormal bone growths), lipping (the formation of a liplike

structure at the end of a bone), osteophytes (bony outgrowths), eburnation (described above), and

arthritis (described above).

WHEN DID DOCTORS BEGIN TO RECOGNIZE TURF TOE?

Doctors began to recognize turf to in the late 1960's because this is when turf was used to replace grass.

There is some evidence that turf becomes harder and less able to absorb shock over time. However, one

study did not find any change in reported turf toe injuries when old and new turf surfaces were

compared.

WHAT ELSE IS TURF TOE KNOWN AS?

Turf toe is also known as turf toe syndrome and metatarsalphalangeal joint sprain.

WHAT IS THE ORIGIN OF THE TERM, TURF TOE?

Turf toe condition got its name because it often occurs to people who play games, such as football, on

hard surfaces such as artificial turf (fake grass).