The simplest definition of turf toe is that it is a sprain of the main joint of the big toe. It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground.
Sprains of the big toe joint became especially prevalent in American football players after artificial turf became more common on playing fields — hence the term “turf toe.” Artificial turf is a harder surface than grass and does not have much “give” when forces are placed on it
Although often associated with football, turf toe occurs in a wide range of sports and activities.
Turf toe can occur in any sport or activity when the forefoot is fixed on the ground, the heel is raised, and a force pushes the big toe into hyperextension.
These injuries most often occur among American football players on artificial grass. Artificial surfaces tend to be harder and less shock absorbent. In addition, the athletic shoes designed for artificial surfaces are softer and more flexible, providing the athlete with more agility, but much less stability in the forefoot.
Most cases of turf toe are treated without surgery. Nonsurgical treatment is determined by the grade of the injury.
- Grade 1. The RICE protocol is recommended for this type of injury: Rest, ice, compression, and elevation. Taping the big toe to the smaller toes will restrict motion. Nonsteroidal anti-inflammatory medications may relieve pain and swelling. Pain is usually tolerable and an athlete can continue sports participation using a stiff-soled shoe. Orthotics, such as a thin, graphite shoe insert with a rigid forefoot component, can reduce stress on the plantar plate and provide stability.
- Grade 2. To keep the MTP joint immobilized, a walking boot may be prescribed for up to a week if needed. Afterwards, these injuries are managed with a taping regimen and the Grade 1 treatments discussed above.
Grade 3. These more severe injuries are most often treated with immobilization for several weeks. The athlete may wear a walking boot or be put in a cast that keeps the big toe in a partially pointed down position. As the injury heals, treatment will gradually step down to Grade 2 and then to Grade 1.
- Physical therapy may be helpful and should be started as soon as symptoms allow. Specific exercises will help to stretch and strengthen the big toe. Early joint movement is essential for reducing or preventing joint stiffness.
Surgery is often not necessary for treating turf toe. However, if your symptoms persist or your level of athletic play is affected, surgery may be an option. Doctors most often recommend surgery for larger Grade 3 injuries, such as:
- A severe tear of the plantar complex.
- Fracture of the sesamoid.
- Vertical instability (unusual up and down motion) of the MTP joint
- Loose bony chip in the joint
- Damage to the cartilage of the joint
- New or worsening bunion
The surgical procedure will vary according to the injury. The aim of surgery is to repair the soft tissues and restore the MTP joint motion so that normal function can be preserved
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