- Also called:
- big toe sprain
- Related Topics:
- sprain
- metatarsophalangeal joint
- toe
turf toe
-
What is turf toe?
Turf toe is a sprain affecting the big toe's metatarsophalangeal (MTP) joint. It occurs when the ligaments at the joint between the metatarsal and basal phalanx are sprained or torn, often from hyperextension of the big toe.
This injury is common in athletes, especially football players on artificial surfaces, due to the use of flexible shoes. However, it can also occur in other sports like wrestling, basketball, and dance. Diagnosis involves physical examination, X-rays, and sometimes MRI to assess the extent of the injury.
Treatment includes rest, ice, compression, and elevation (RICE). More severe cases may require prolonged rest or even surgery.
2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
Which part of the body does turf toe affect?
Turf toe affects the metatarsophalangeal (MTP) joint of the big toe. This joint plays a key role in running and sudden changes of direction, so an injury can cause significant disability. Turf toe is a sprain, or sometimes a tear, of the ligaments at the joint between the metatarsal and basal phalanx. Symptoms include tenderness, swelling, and pain with movement.
2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
How does turf toe usually happen?
Turf toe is a sprain of the big toe's metatarsophalangeal joint (MTP). Hyperextension of the big toe is the most common injury mechanism. This often occurs in American football when a tackler's force is directed down the lower leg into the foot, causing an exaggerated dorsiflexion and subsequent hyperextension of the big toe while the forefoot is fixed on the playing surface with the heel raised.
Artificial playing surfaces and flexible-soled turf shoes are the two main causes of turf toe. Artificial surfaces, introduced in the 1960s, dramatically increased turf toe injuries due to the increased friction between the artificial surface and the shoe.
2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
What are common signs and symptoms of turf toe?
Turf toe is a sprain of the big toe's metatarsophalangeal joint (MTP). It results from injuries, often hyperextension, to the ligaments around the big toe.
Symptoms and signs include tenderness, swelling, and pain during movement of the MTP joint. The severity of turf toe injuries are classified into Grades I-III. Grade I has minimal symptoms, such as minor swelling. Grade II involves a partial ligament tear, causing pain when bearing weight, bruising, and limited motion. Grade III, the most severe, is a complete tear with considerable pain, swelling, bruising, and inability to bear weight.
2 Britannica SourcesCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
How is turf toe diagnosed by doctors?
Turf toe is diagnosed through a combination of methods. Doctors begin by discussing how the injury occurred and, if available, watching a video replay of the event. The MTP joint is examined for tenderness, swelling, and pain during movement.
If turf toe is suspected, X-rays are taken from different angles to assess any injuries to the structures around the MTP joint. If the X-rays show abnormalities, an MRI scan may be ordered to evaluate soft tissue, cartilage damage, and any bony issues. Injuries are typically graded from I to III, with Grade III being the most severe.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles. -
What treatments can help someone recover from turf toe?
The initial treatment for turf toe injuries includes rest, ice, compression, and elevation (RICE). Athletes with Grade I injuries may return to play immediately, possibly with toe taping or stiff insoles. Grade II injuries often need up to two weeks of rest. Grade III injuries may require keeping weight off the foot for several days and prolonged rest, typically two to six weeks.
Athletes should gradually progress from walking to running, cutting, and sport-specific activities. A pain-free range of motion of 50–60 degrees of upward flexion is proposed as a criterion for returning to play.
Surgery is reserved for severe injuries, like large bone fractures at the site of ligament attachment with an unstable joint, or when conservative therapy fails.
1 Britannica SourceCreated from Britannica articles using AI. AI can make mistakes, so verify using Britannica articles.
turf toe, sprain involving the big toe (hallux) metatarsophalangeal (MTP) joint of the foot. The term turf toe was coined in 1976 after it was found that the frequency of injuries to the MTP joint of the big toe was increased in gridiron football players who wore relatively flexible soccer-style shoes when playing on artificial (AstroTurf) surfaces. The injury is fairly common, particularly among gridiron football players who play on artificial grass, but it also occurs in individuals who participate in other sports or activities, including wrestling, basketball, and dance. Because the MTP joint of the big toe plays a key role in running, sprinting, and cutting (sudden change of direction), an injury can result in significant functional disability. It is thought to be underreported and not always appreciated as the significant injury that it may be or can become if it is not managed appropriately.
Anatomy of the big toe MTP
The anatomy of the forefoot is intricate and quite complicated. The MTP joint of the big toe involves a metatarsal (long bone) with a rounded, cartilage-covered surface at the end, which joins with the concave base of the phalanx (toe bone). Stability of the MTP joint in the big toe comes from the collateral and metatarsosesamoid ligaments, which are located on the medial (inside) and lateral (outside) sides of the big toe, as well as from the plantar plate of the big toe (a thick fibrocartilage structure at the base of the MTP joint). There are also several different muscle tendons that run along either side and underneath the joint, attaching onto the phalanx. These structures together make up the intricate capsuloligamentous complex (joint capsule, plantar plate, and adjoining ligaments) of the first MTP joint.
Motion in the MTP joint of the big toe consists primarily of plantar flexion (downward flex) and dorsiflexion (upward flex). Passive range of motion varies widely from 3°–43° of plantar flexion and from 40°–100° of dorsiflexion.
" height="20" alt="HEW Logo">
Causes of turf toe
The two primary causes of turf toe are the advent of artificial playing surfaces and the introduction of flexible-soled turf shoes. Artificial playing surfaces were introduced in the 1960s, and with that came a dramatic increase in the number of turf toe injuries. The injuries were associated with increased friction caused by the artificial surface and shoe interface. Shoes designed for play on a traditional grass surface possessed a metal plate in the sole. But after playing on an artificial surface with shoes designed for grass surfaces, players complained of traction problems. In response, a more-flexible turf shoe was introduced. Free from the stability provided by the metal plate, the turf shoe exposed the MTP joints and the forefoot to greater physical stress.
Injury mechanism
The most common mechanism of injury in turf toe is hyperextension (extension beyond the normal range of motion) of the big toe. This often occurs with tackling in American football, where the forefoot is fixed on the playing surface with the heel raised in a dorsiflexed position. A force from the tackler is thus directed down the lower leg into the foot, causing an exaggerated dorsiflexion and subsequent hyperextension of the big toe. Hyperextension can lead to varying degrees of injury to the plantar plate, joint capsule, and collateral ligaments or cartilage surface of the bone.
Although most turf toe injuries occur with hyperextension, other mechanisms have been described as well. Hyperflexion, or “sand toe” (so-called because of its increased prevalence among beach volleyball players), is sometimes considered a variation of turf toe, although it often has a different clinical course.
Varus (bending inside) and valgus (bending outside) are two other described mechanisms. Valgus is most commonly seen in a football lineman who is pushing off from a stance. Varus is rarely seen but can occur when an outward force is applied to a fixed forefoot.
The trusted destination for professionals, college students, and lifelong learners.
SUBSCRIBE
Diagnosis and treatment
The diagnosis of turf toe is made by first eliciting how the injury occurred and, if available, watching a video replay of the incident. Patients may present with a single acute episode or multiple episodes of trauma. The MTP joint typically exhibits tenderness, swelling, and pain with movement. At this point, if a turf toe diagnosis is suspected, X-rays with several different views are used to assess injuries to the structures associated with the MTP joint. A magnetic resonance imaging (MRI) scan can be ordered if there are abnormalities on the X-ray. MRI is used to assess soft tissue and cartilage damage and to evaluate bony abnormalities.
Most injuries are graded on a scale of I to III, with III being the most severe. Grade I is a stretch injury to the capsuloligamentous complex, generally with minimal symptoms, such as light swelling. Grade II is a partial tear to the capsuloligamentous complex, accompanied by pain on weight bearing, by bruising, and by restricted range of motion. Grade III is a complete tear of the capsuloligamentous complex. In this type of injury, the plantar plate is separated from the metatarsal, and the phalanx strikes the adjacent part of the metatarsal (the metatarsal head). Sometimes the injury results in the movement of the sesamoid bones (small bones located beneath the MTP joint). There is severe pain, swelling, bruising, and motion restriction, along with inability to bear weight.
The initial treatment of an acute turf toe injury generally includes the RICE protocol: rest, ice, compression, and elevation. Athletes with Grade I injuries often can return to play immediately, although toe taping and the use of a stiff insole may be necessary or desired for protection. Grade II injuries often require up to two weeks of rest. Patients with Grade III injuries may need to keep weight off the affected foot for several days and have prolonged rest, usually for two to six weeks. The athlete slowly progresses from walking to running to cutting and, finally, to sport-specific activities. Pain-free range of motion of 50°–60° of upward flexion has also been proposed as a criterion for returning to play. Operative treatment is reserved for the most severe turf toe injuries, including large capsular avulsions (bone fractures at the site of ligament attachment) with an unstable joint and an abnormal separation of a bipartite sesamoid (a sesamoid bone that exists in a natural state of fracture). Operative treatment also may be used after conservative therapy has failed.