Turf toe is a sprain of the big toe joint which results from injury during sports activities. The injury usually comes from excessive upward bending of the big toe joint. This condition can be caused from either jamming the toe or from repetitive injury when one pushes off repeatedly from jumping or running.
With turf toe the injury is quick. It is most commonly seen in athletes playing on artificial surfaces, which is harder than grass and which cleats easily stick to. The term, “Turf Toe” came from athletes who play on artificial turf. Playing sports on artificial turf can cause the foot to stick to the hard surface. This results the big toe joint becoming jammed. There has been some proof that less-supportive flexible shoes worn on artificial turf can also cause this injury. Many times the injury occurs in athletes that wear flexible soccer-style shoes that allow the foot to bend too much. It can also happen on grass surface, especially if the shoes being worn do not provide adequate support for the foot. Activities i.e. football, basketball, soccer, field hockey and lacrosse show the highest degree of injury to the great toe joint on artificial surfaces. Other non-sporting causes include shoe gear changes, limited range of motion of the great toe joint, and flat foot conditions.
When walking or running, each step begins with raising the heel and letting the body’s weight come forward onto the ball of the foot. At a certain point an individual propels themselves forward by “pushing off” with the big toe and allows the weight to shift to the other foot. For some reason if the toe stays flat on the ground and doesn’t lift to push off, there is the risk of quickly injuring the area around the joint. Another scenario is if being tackled or falling forward and the big toe stays flat, the effect is the same as if sitting and bending the big toe back beyond its normal limit. This causes hyperextension of the toe. That hyperextension, repeated over time or with enough force, can cause a sprain in the ligaments around the joint.
Cause Of Injury: Two Ways
The most common causes:
- Hyperextension of the big toe joint. The big toe joint becomes hyper-extended when the heel raises off the ground.
- External force is placed on the big toe and the soft tissue that supports the big toe is torn or ruptured.
Symptoms of acute injury include
- Tenderness and
- Swelling of the big toe joint
There is usually a sudden onset of pain in the pushing-off phase when running. However, there is not enough pain to keep an athlete from a physical activity or finishing a game. This in turn causes further damage to the big toe and dramatically increases healing time.
Big Toe Injuries That Cause Turf Toe Fall Into 3 Grades.
Grade 1: This type of turf toe injury is considered to be mild as the supporting soft tissue structure for the big toe are only sprained or over stretched. This is the most common type of injury. There is minimal swelling with mild tenderness and usually no black and blue bruising.
Grade 2: This type of turf toe injury is considered moderate in severity. It presents more diffuse tenderness, swelling, restricted range of motion and mildl black and blue bruising. Often there is a partial tear of the supporting ligaments but no articular cartilage damage.
Grade 3: This type of turf toe injury is considered severe because of the:
- Substantial swelling, pain from palpation,
- Restriction of range of motion,
- Inability to bear any weight on the injured foot and diffuse black-and-blue bruising of the big toe.
- Tears to the joint capsule, ruptured ligaments and possibly compression damage to the articular cartilage of the big toe.
Premier Treatment For Turf Toe:
Treatment centers on individual basis and the severity of the injury. The following are general guidelines for turf toe injuries.
“R.I.C.E” Is Utilized.
- “R” is for rest and is the main component to allow for successful healing. But, this is the greatest area of noncompliance because an athlete assumes the injury is not severe enough to miss a game or practice.
- “I” is for ice, this is usually performed for the first 48-72 hours after the injury. Cryotherapy involves placing the injured toe in a bucket of ice water for 15-20 minute intervals.
- “C” is for compression, this is done by taping the great toe in a compression dressing or strapping.
- “E: is for elevation but in this case it is for equipment modification or change.
An example, using a much stiffer athletic shoe that will resist motion of the big toe. And/or the insertion of an orthotic to increase support of the big toe.
Additionally, strapping the big toe to limit motion can allow an athlete to return to play quicker. Non-steroidal anti-inflammatory drugs (NSAID’s) may be utilized for relief of minor pain, as well as, to decrease inflammation.
- Grade 1: injuries do well with strapping and usually only require a few days of rest.
- Grade 2: injuries should adhere to the “RICE” principles above and usually require one to two weeks of missed practices and games.
- Grade 3: injuries are more severe injuries and the healing process may take four to six weeks of recovery time from physical activities. Sometimes, Grade III turf toe injuries do not heal appropriately with conservative care and result in chronic pain and instability. Surgical reconstruction of the joint capsule, ligaments and articular cartilage may be necessary to restore proper alignment and function in these extreme cases.