What is Turf Toe?

Turf Toe is a sprain injury to the big toe joint (also known as the 1^st MPJ, hallux or great toe). The incidence of this injury has increased over the years secondary to athletic fields being covered by artificial turf and also by increased flexibility of the toe box in athletic shoes.

The rough nature of many contact sports is a factor involving abnormal extension, flexion and rotational movements that cause injury to joints and soft tissue structures. One such injury is a sprain to the big toe joint, commonly referred to as turf toe. Turf toe is seen most common in football, but it can occur in any activity, such as soccer, tennis, volleyball, wrestling and even dancing.

The big toe joint is composed of 4 bones, 9 ligaments, 3 muscular attachments and the joint capsule (which is considered a ligament). Two of the bones are called sesmoids, which are encapsulated inside a tendon and the other are two are 1^stmetatarsal bone and the proximal phalanx (your toe, which moves up and down). Your big toe joint has a large range of motion in two main directions: dorsiflexion (toe going up) and plantarflexion (toe going down). This is required for normal ambulation, however when this range of motion is exceeded, you get turf toe.

The most common example of turf toe is in a football player. If you can imagine a football player at the start of a play, you will notice that the athlete has their foot planted on the ground, the big toe joint hyperdorsiflexes (bending more than it should) and the heel is raised up off the ground. During an applied downward force (up to 8 times his/her body weight), the big toe is dorsiflexed beyond its biomechanical limits, resulting in tear of the joint capsule.

The initial treatment of turf toe is RICE: rest, ice, compression and elevation. In the initial stages of suspected turf toe, taping is not recommended due to the swelling that occurs and the possibility of neurovascular compromise. Is you suspect that you may have a turf toe injury, call your podiatrist and have them take x-rays to rule out a possible fracture. 

By David Hunnicutt