Most people don’t give their big toes a lot of thought. However, the importance of these digits, in what’s referred to as the plantar complex part of the foot, becomes much more clear with a condition like a turf toe injury.
The primary function of the big toe is to help disperse body weight through the foot in the direction a person is traveling.
Obviously, this is especially important for athletes, both professional and amateur, but anyone can develop this big toe problem if the plantar complex area of their feet are continually stressed and overused.
With turf toe, not only is there likely pain and inflammation in the toe, but a person’s mobility, coordination, and balance can also suffer. Fortunately, there are treatment approaches for this condition.
Understanding more about this condition, along with the causes and symptoms, can help people seek early intervention and experience better turf toe recovery time.
What is Turf Toe?
Put simply, turf toe is a metatarsophalangeal joint sprain or injury to the big toe joint. The Metatarsophalangeal Joint (MTP) is where the big toe and foot bones meet and this area of the foot makes up what is known as the plantar complex.
Just behind the first-toe metatarsal joint is a tendon that connects two round bones called sesamoids.
The sesamoid bones help support our bodyweight when standing and engage the tendon while walking and running.
If this area of the big toe is repeatedly stressed or is involved in an acute hyperextension injury, it can cause the tendon to become inflamed, painful, and lead to weakness.
A metatarsophalangeal joint sprain or injury to the plantar complex area of the foot is generally one of three types.
First, it may be that excessive stretching has led to noticeable symptoms.
Second, partial tearing of tendon will make symptoms, like inflammation, tenderness, and maybe even some bruising obvious.
Finally, a full rupture or tear will cause severe swelling, soreness, bruising, and make the big toe very painful to move.
Causes of Turf Toe
Turf Toe is a condition that is caused when the big toe is hyperextended or bent beyond its normal limit up toward the front of the foot. This is what begins to stress and irritate the tendons and ligaments.
It’s called “turf toe” because on artificial turf, athletes like soccer and football players can experience displacement of this joint when using their big toe to grip or dig forward while trying to sprint. In fact, it is one of the most common types of football injuries.
However, dancers, tennis players, basketball players, gymnasts, weightlifters or simply anyone who repeatedly flexes the big toe on hard surfaces can develop a turf toe injury.
While sudden trauma to the big toe joint can lead to this type of injury, more often it’s continued overuse that causes the condition to worsen over time.
Some of the more common causes of a turf toe injury can include:
- Poor fitting footwear that leads to a lack of support for the big toe joint, especially during sports play or exercise
- Wearing high-heels can place extra pressure on the plantar complex and cause this condition
- Sports with a lot of quick stops, starts, and direction changes are likely to see a lot of turf toe injuries
- Poor form in walking or running that places too much pressure on the big toe
The symptoms of a turf toe injury can range from unpleasant to severe.
Turf Toe Injury Symptoms
With sudden injury, symptoms of turf toe can develop instantly, but with continued overuse, signs of the injury are usually more gradual.
At first, discomfort might just be annoying, but without treatment or a change in activity, the issues tend to worsen.
Some of the most common turf toe injury symptoms can include:
- Clicking or popping sensation in the big toe
- Stiffness or swelling around the toe
- Moderate to severe pain when putting weight on the toe or trying to flex or bend it
- A lack or loss of movement in the big toe
Recognizing the early signs of the condition is important, but even with longer-term turf toe injuries, there are treatment options available.
Turf Toe Treatment
The typical turf toe recovery time will vary depending on the severity of the injury and the length of time it has gone unnoticed.
A minor grade 1 injury may heal in a week or less, whereas a grade 2 injury can sideline a player for several weeks. For the most severe grade 3 types, the turf toe recovery time could take several months to completely heal and may require a boot or cast to immobilize the toe.
Diagnosing this condition will involve a physical examination, as well as a discussion about recent or long-term physical activities as well as a discussion of symptoms.
Some physicians will suggest x-rays, an MRI, or ultra-sound imaging to rule out other possible causes, such as fractured bones in the plantar complex.
The first approach to reducing mild turf toe recovery time is usually the RICE Method (Rest, Ice, Compression, and Elevation). It may be that the tendon has been overextended and simply needs time to heal.
While resting the toe, icing it can reduce inflammation and help with the pain. In between icing sessions, use a compression bandage or tape to immobilize the toe and elevate it above the heart while lying down with the foot on a pillow or cushion.
The RICE method can be used with acetaminophen (Tylenol) for pain, or over-the-counter nonsteroidal pain relievers like ibuprofen (Advil) or naproxen (Aleve) to help with both pain and inflammation.
Other treatment options can include the following:
1. Turf Toe Brace
A turf toe brace or boot might be suggested as a way to support and lessen the stress placed on the toe while it’s healing. It may take a week or more in the boot before a person is comfortable putting weight on the first toe joint.
2. Turf Toe Taping
Turf toe taping is another way to support this joint from displacing or sliding around in footwear, but it is equally as important to use appropriate footwear for whatever activity is being performed. There are videos online that show the proper way to tape the injury.
3. Physical Therapy
Physical therapy can be beneficial for a variety of reasons. First, sports therapists can teach proper techniques that will help prevent further injury, as well teaching turf toe exercises to strengthen the plantar complex and make it more flexible.
4. Shockwave Therapy (ESWT)
A STORZ Shockwave Machine delivers high-pressure impulse waves to the big toe joint, which increases blood flow, reduces inflammation, creates new blood vessels and promotes faster healing.
Because Shockwave Therapy is a nonsurgical procedure, therapy sessions can be performed during physical therapy or at any point in the healing process.
While surgery is fairly rare for this condition, it may be necessary with extreme injuries, or when all other treatment options have failed. Surgical treatment is a last resort, however, due to the inherent risks of any surgery, as well as the extended healing time.
A Turf Toe injury from a metatarsophalangeal joint sprain, overuse, or repetitive movements can cause painful symptoms that may limit movement or mobility for professional and amateur athletes alike.
At the first sign of pain in the toes, it’s important to speak with a doctor or trainer to avoid doing further injury. Until that time, resting the injury is recommended and it’s necessary to keep abstain from placing weight on the foot and toes.
The treatment methods discussed here should decrease the pain and inflammation and help speed up the recovery process.
Sesamoid bone image courtesy of Jmarchn.