Turf Toe Anatomy, Symptoms & Treatment

Turf Toe Anatomy

Turf Toe is a common injury to the big toe joint. The term toe originated from using artificial pitches for playing sports, as these types of playing surfaces are hard and can become very slippery when wet. This leads to increased amounts of trips and slips. It can become painful if the big toe joint becomes overstretched along with the surrounding soft tissue structures. When this occurs, it is referred to as Turf Toe. The medical term for this is a metatarsophalangeal joint sprain.

Turf Toe Causes

Hyperextension or pulling upward of the big toe joint can overstretch the tendons and ligaments attaching to the big toe. The soft tissue becomes painful in the big toe joint when this occurs. Another cause of turf toe is repetitive compression of the big toe which irritates the joint.

Mechanisms of turf toe injury are often quick such as a slip or trip when sprinting or if there is impact to the joint from an instrument such as a hockey stick or front hitting the big toe off a wall.

Other causes are kneeling, BJJ, football, and wearing high heels, commonly seen in dancers.

Turf Toe Symptoms

Turf toe symptoms include
Pain on the base of the big toe
Mild swelling around the big toe joint
Pain on Weight bear or hurts to walk
Increasing pain with repetitive use of the big toe
Bruising around the joint

Turf Toe Diagnosis

A consultation with a Sports Medicine Doctor, a foot specialist, or a Physical Therapist can help establish a turf toe diagnosis. A careful clinical interview followed by a clinical assessment is sufficient to establish a diagnosis and a grading of the ligament tear.

From that point, a referral may be made for a scan to confirm the diagnosis. An MRI is the most accurate form of scan for diagnosis of Turf Toe, while an ultrasound is a cost-effective alternative.

An x-ray is unable to diagnose Turf Toe.

Turf Toe Diagram

Turf Toe Grading

Grade 1

This is usually overstretching or less than 10% tear of the soft tissue structures around the big toe. Treatment can involve taping, icing, rest, and compression. There may be subtle bruising, and return to play may be immediate with some additional support.

Grade 2

This is the sign of a partial tear of the ligaments or tendons around the joint. The R.I.C.E principle may be applied initially to protect the joint and provide pain relief. Pain levels are often higher than a grade 1 tear, with more visible swelling and bruising. A period of rest and immobilization from sport and exercise may be required.

Grade 3

This is a complete tear or rupture of the surrounding ligaments of the big toe. It is often associated with a dislocation of the big toe. Immediate immobilization is necessary, and surgery may be considered for these cases depending on the individual’s activity levels. With a Grade 3 tear, there may be an avulsion fracture, so imaging such as an MRI is recommended.

Turf Toe Treatment

In the initial instance, home remedies such as ice, compression, and offloading are beneficial for reducing pain levels and protecting the joint. Turf toe taping using zinc oxide rather than KT Tape may be applied by a Physical Therapist or a splint to protect the joint.

If the injury results from repetitive motion, gait analysis may be required to identify what is causing an overload of the big toe joint. Footwear advice for stability shoes or custom insoles may be required to support the foot and ankle.

A Physical Therapist may prescribe strengthening exercises alongside balance and stability exercises to facilitate optimal foot movement.

Steroid injections are sometimes used to reduce inflammation in the joint. This is not common in a typical clinical setting but may be used in a sporting environment.

Surgery is rare for turf toe and only for Grade 3 injuries. This may stabilize a fracture, correct a deviating big toe, remove a loose body, or preserve the joint from developing arthritis.

Turf Toe Taping

Turf Toe Taping aims to provide stability to the big toe joint so it can’t go into hyperextension. This should be done with rigid zinc oxide tape as KT Tape is too stretchy.

Follow the steps below for Turf Toe Taping:

Place the patient in sitting with the foot hanging, relaxed over a bench
Place an anchor (loop) around the midfoot and the base of the big toe joint
Keeping the big toe neutral, apply strips of tape on the underside of the foot from one anchor to the other.
Re-apply the anchors to lock down the strips of tape.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Turf Toe