Ask the c.Ped – What is Turf Toe?

Helen Russell

Helen Russell is the owner of Metro Run and Walk with her husband Mark. She is a certified pedorthist and has completed several marathons!

For our children, back to school often signals time to get back to their pursuit of fitness or physical sports either through lessons, club teams, or school teams.  The ones that most quickly come to mind are dance, soccer, football, field hockey, and cross-country running. Several of these sports carry risk for a different type of injury known as “turf toe.”

Turf toe is a sprain to the ligaments around the big toe joint.  Though it’s most commonly associated with football and soccer players who play on artificial turf — hence the name “turf” toe — it can happen to anyone who is doing something that causes the big toe to be extended beyond its normal range of motion.

The big toe joint is instrumental in walking as you propel forward by pushing off your big toe.  If your big toe stays on the ground, stays flat, or hyper-extends, you run the risk of injuring the joint.

Often, the injury is sudden, there may be a “pop” and pain is felt almost immediately.  Swelling is not uncommon.  It is common for the athlete to avoid pushing off the big toe due to the pain.  As soon as possible, seek medical attention.  The health care provider will likely take an x-ray to rule out a fracture, a dislocation or other bone issues. On occasion, advanced imaging studies such as a bone scan; CT scan; or MRI will be employed.

An accurate diagnosis is crucial in proper treatment of the injury.  Once a diagnosis of turf toe is made, treatment plans vary depending on the severity of the injury.

Turf Toe Classification

Grade I: Micro- or minor tearing of the capsuloligamentous complex of the big toe joint.  Symptoms:  Localized tenderness with minimal swelling and no bruising

Grade II: Moderate injury or partial tear of the capsuloligamentous complex of the big toe joint Symptoms:  Widespread tenderness with mild to moderate swelling and bruising. Range of motion is moderately restricted and there is pain with weight bearing.

Grade III: Severe sprain with possible associated fracture or complete tear of the capsuloligamentous complex of the joint.    Symptoms:  Severe and diffuse tenderness and swelling, moderate to severe bruising, and painful range of motion.

Depending on the classification of injury, treatment may include:

  • RICE:  Rest, Ice, Compression, Elevation
  • Rest may include crutches to take the weight off the toe.
  • Anti-inflammatories
  • A brace to protect the toe – or at the very least a shoe that has a firm sole that will not allow bending.
  • Ultrasound or other electrotherapy treatment.
  • Taping the toe to prevent movement.
  • A stiff insert such as a Morton’s extension, orthotic, or shoe insert
  • Physical therapy, rehabilitation and/or a strengthening program

The goal of treatment is to return the athlete to competition, without risk of further injury.

References:

American Academy of Podiatric Sports Medicine, What is Turf Toe and How is it Treated? http://aapsm.org/turf_toe.html

Sports Injury Clinic, What is Turf Toe?  http://www.sportsinjuryclinic.net/cybertherapist/front/foot/turftoe.htm

Contemporary Pedorthics, Wayne Decker, C.Ped. and Stephen Albert, DPM,C.Ped

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