Turf Toe – An Avoidable Injury

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Most of us have experienced pain in the area of our big toe (Turf toe) in our lives. This happens not only to runners or footballers but also to people who take part in hiking, climbing stairs, wearing high heels, and those who probably get it because of a sudden toe movement. By definition, a turf toe is a sprain in the main joint of the big toe. This happens when we forcibly bent our ligament into hyperextension while pushing off into a sprint or wearing high heels for a long time etc.

The name Turf toe came because it was first identified in an American football player playing on artificial turf. 

Foot Anatomy

turf toe

Avoiding big medical and scientific terms, we can simply say that the big toe consists of two joints. The largest of the two joints is the metatarsophalangeal joint (Just remember MTP and forget the long word). Important structures surround the MTP, which hold it in place and prevent dislocation. 

What exactly is injured in turf toe

The injury is of the soft tissue structure in and around the MTP area. This injury can vary in severity and hence can be categorized into three stages:-

Stage 1 : This is when the ligament or soft tissue is stretched causing pin-point tenderness and inflammation. Pain occurs while moving the toe area however one feels that it is manageable. 

Stage 2 : A small/ partial tear occurs in the ligament. This leads to tenderness, inflammation, and burning feeling in a larger area around the MTP. One feels severe pain while moving the big toe.

Stage 3 : The ligament or the soft tissue has a tear causing severe tenderness, severe swelling, and bruising. This stage is extremely painful and one is not able to move the big toe.

What causes the injury?

Turf toe occurs when we extend our forefoot in a way where we raise the heel without moving the toe leading to hyperextension. If the hyperextension motion is repetitive, soon we will be in Stage 1. At this point, if we do not eliminate the cause and control the trauma, it will lead to stage 2 followed by stage 3.

The injury can also occur when we have a single episode of sudden move causing large hyperextension of the ligament. Sometimes we are also able to hear a click sound as if something has snapped. This setting in of the injury is fast and can happen in just one step. Jumping and wrongly landing, sudden sprint with wrong body posture, etc. are contributing factors. Here generally we land up in stage 2 or stage 3 directly.

First Aid

Irrespective of the stage or cause, the first treatment is to immediately apply ice so that inflammation is reduced. One should rest the foot and try some compression. This treatment will help reduce inflammation and hence pain in the general area. Over-the-counter anti-inflammatory may also be taken as per the advice of the doctor. Once we control the initial damage, we need to sit down and check the stage of injury.

Examination 

If you can move your big toe but on movement it causes pain. Probably you are in stage 1. Here generally there is no pain when we are resting our foot.

If the pain is constant and increases many folds when you move the area, probably you are in stage 2. Here you will be able to see swelling and feel the tenderness in the general area. Resting will bring relief.

If the pain is constant and severe. The inflammation is also visible and anti-inflammatory is not helping much, probably you are in stage 3. 

You may need to get an X-ray or an MRI done to ascertain the extent of the injury.

Treatment

Stage 1 : Follow R.I.C.E protocol (Rest, Ice, Compression, and Elevation). Taping the big toe to the smaller toes will restrict motion. NSAID may relieve pain and inflammation. Do not continue the activity which caused the injury. Recovery may take about 7 to 10 days.

Stage 2 : it is important to keep the MTP joint completely immobilized. Once the severity decreases, follow the stage 1 protocol. Recovery may take about 10 to 20 days.

Stage 3 : This is a more severe injury. One needs to keep one foot immobilized for many weeks. You can wear walking shoes or use insert’s to keep the big toe flat or pointing downwards. Once the situation improves, one can move to stage 2 and then stage 1 protocol. At times, in stage 3 the normal treatment may not work and one may need surgical intervention.

Rehabilitation Exercises 

Once we have recovered from the injury, we must refrain from starting physical activity immediately. We need to work towards slowly increasing the flexibility of the ligament and strengthen the area around it. Hence perform the set of exercises shown in the video regularly for several months. Start physical activity in a graded manner thereby allowing the big toe to adapt to the load.  

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