Turf Toe

Turf toe (or metatarsalphalangeal joint sprain) affects the joint between the foot and one of the toes, especially the big toe. 'Turf' refers to manmade Astroturf or similar surfaces, which during activity can cause a gripping motion in certain footwear that results in overextension of the toes.

Symptoms

Moving or stretching the injured toe, particularly upwards, will be painful. Pressure to the toe can also cause pain, such as attempting to stand on tiptoes or pressing against the floor in sprinting. The area around the joint may be tender, and can be bruised, inflamed, reddened, or excessively hot. The pain is often not limited to one toe and may be felt in the rest of the foot, causing an unnatural gait. Your toe or foot may feel inflexible.

Causes

Shoes hold on to artificial turf more readily than real grass, and in these moments of being 'stuck' one of your toes can bend too far as you fall forwards in position. This can damage the joint and the ligaments. Great flexibility in your footwear – common to athletic shoes – can actually enhance this risk, as they allow your toes to overextend. Shoes that grasp the floor (with studs, for example) increase the likelihood of becoming 'stuck' and provoking the injury. Away from Astroturf, athletes including martial artists and gymnasts are prone to the condition as these activities involve a focus on foot stances and manoeuvres.

Treatment

You should ice the injury regularly, and compress the area using an appropriate bandage. Elevate the toe for the first day or two. Do not put unnecessary strain on the area; this means ceasing the activity that contributed to the condition and any others that are liable to exacerbate the injury. Rest in this way, and by using walking aids if needed, until the pain has subsided. Try to shield the toe as much as possible, for instance by wearing rigid shoes. Anti-inflammatory medication may be beneficial but check with a doctor.

As the injury can sometimes be accompanied by a broken bone or stress fracture (see our article for further information), consult a medical professional. They will conduct a physical exam and may recommend further tests as required. They can also assist in taping or otherwise compressing the toe, and recommend suitable training to assist the recovery process. A physical therapist will be able to advise on a stretching and strengthening program in order to keep your toe moving. Without gentle motion exercises the injury can be worsened, potentially resulting in a form of arthritis called hallux limitus

If a minor injury is treated correctly then your symptoms might begin to diminish by the third or fourth day, though relatively full healing may take a month. However, in many cases of turf toe the injured party often retains lingering negative symptoms for years afterwards, which should be treated if and when they are encountered.

Prevention

In addition to wearing rigid shoes where feasible and limiting contact with artificial turf, you should keep the previously injured toe taped constantly and add suitable orthotics to your footwear. You should tackle overpronation or weight problems if applicable.