Turf Toe: Causes, Symptoms & Treatments

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.

What Causes Turf Toe?

Turf toe is a sprain to the ligaments around the big toe joint, which works primarily as a hinge to permit up and down motion. Just behind the big toe joint in the ball of your foot are two pea-shaped bones embedded in the tendon that moves your big toe. Called sesamoids, these bones work like a pulley for the tendon and provide leverage when you walk or run. They also absorb the weight that presses on the ball of the foot.

When you are walking or running, you start each subsequent step by raising your heel and letting your body weight come forward onto the ball of your foot. At a certain point you propel yourself forward by “pushing off” of your big toe and allowing your weight to shift to the other foot. If the toe for some reason stays flat on the ground and doesn’t lift to push off, you run the risk of suddenly injuring the area around the joint. Or if you are tackled or fall forward and the toe stays flat, the effect is the same as if you were sitting and bending your big toe back by hand beyond its normal limit, causing hyperextension of the toe. That hyperextension, repeated over time or with enough sudden force, can cause a sprain in the ligaments that surround the joint.

Typically with turf toe, the injury is sudden. It is most commonly seen in athletes playing on artificial surfaces, which are harder than grass surfaces and to which cleats are more likely to stick. It can also happen on a grass surface, especially if the shoe being worn doesn’t provide adequate support for the foot. Often the injury occurs in athletes wearing flexible soccer-style shoes that let the foot bend too far forward.

Turf Toe Symptoms and Signs

Turf toe usually has a traumatic sudden onset; most athletes suffering from this injury will recall exactly when and how the injury happened. An athlete who suffers from turf toe may complain of pain around the ball of the foot, particularly on the bottom or plantar surface of the MTP joint. Depending on the severity of the injury, this pain may be present with or without movement, when the toe is bent up toward the body (dorsiflexion of the great toe), or in the toe off portion of the stance phase of gait, and/or against isometric resistance. Intra and/or extracapsular swelling of the joint may be present. Reduction of strength and range of motion is also seen in acute and chronic ranges of motion. Pain and loss of function of the joint and tissues around the joint may cause difficulty walking and maintaining balance.

A good general guideline is to compare the injured side to the uninjured side. The injured tissues may cause a lump or gap or a “crunchy” feeling at that location from the inflammation. There is typically tenderness and there may be warmth, swelling, and iscoloration.

Treatment for Turf Toe?

Ice the injury immediately. Applying cold therapy or ice to the injured joint will reduce pain and inflammation speeding up the healing process. Apply a compression bandage.This will help support and protect the toe as well as reduce swelling. The sooner a compression bandage is applied the earlier it will prevent swelling although a compression bandage should only be applied for 10 minutes at a time or it may restrict blood flow to tissues and cause further damage.

Rest, which might include crutches to take the weight off the toe. it is difficult to rest the foot when you need to walk on it but without rest turf toe will take much longer to heal. Use a brace to protect the toe or at the very least wear a shoe that has a firm sole that will not allow bending. A turf toe taping technique will support and protect the toe preventing it from bending in the direction that will stress the toe ligament causing pain.

See a sports injury professional for advice watch our expert interview podiatrist on toe pain. This is especially important if the injury is severe or doesnt heal as expected.