Turf Toe: symptoms, treatments & prevention

What is Turf Toe?

Turf toe can strike on any surface, but it’s most common to find it in any sport that combines artificial turf with light, flexible shoes that don’t offer much support around the toes. The toes are more likely to be fixed, or stick to artificial turf than natural grass, increasing chances of a toe sprain, hence the name turf toe.

The footwork involved with football, soccer, rugby, and basketball can increase your risk of developing turf toe. Studies confirm that turf toe is the third most common injury benching college athletes, followed closely behind knee and ankle injuries.

Beach volleyball players, with their perplexing need to be barefoot while playing a sport, suffer the same injury, but they call it "sand toe."

Turf Toe Symptoms

Turf toe can vary in its severity. The mildest forms will manifest as a slight sprain, with pain in the joint and swelling and bruising.

In more severe cases, you might hear a “popping” noise at the time of the injury, your range of motion could be limited, and your capsule and ligaments could be partially torn. The most severe cases involve a dislocation of the joint.

Conservative Treatments for Turf Toe

Most cases of turf toe heal with conservative treatments, and can include:

• Immobilize the great toe joint in a splint with the toe pointing down allowing the plantar plate to heal in a stable position

• Elevate the foot for a few hours every day and at night

• Apply ice for at least 15 minutes throughout the day

• Anti-inflammatories to help with pain and swelling
• After 2-4 weeks, gradually introduce physical therapy and range of motion, up to 6 weeks if it is more severe

Surgical Treatments for Turf Toe

If the pain or instability in the toe persists, surgery may be recommended. Surgery may also be need if there is cartilage damage or bone deformity as a result of the injury. The surgery that is required depends on the amount of damage to the toe/ligaments.

If the ligaments alone are disrupted, the soft tissue can be repaired end to end with strong sutures or bone anchors. If there is a traumatic bony deformity, bone cuts may need to be made to reposition and realign the joint. If articular damage is present, the surgeon may opt to perform a cartilage transplant or perform microfracture surgery to re-grow cartilage in the joint.

After surgery, the toe is usually immobilized in a cast as it heals. This can cause stiffness in the joint. A new technique to reduce scarring and stiffness in the joint is an amniotic membrane injection. Amniotic membrane, harvested from placental membrane, have regenerative properties that reduce scarring after surgery, resulting in less stiffness after surgery.

Preventing Turf Toe Complications

Do not rush your return to sports! Turf toe is notorious for its lingering symptoms, and you don’t want a one-time sprain to turn into a chronic condition. Astoundingly, half of all athletes who sustain a turf toe injury can still feel symptoms up to five years later.

The bottom line is to try to avoid jamming the big toe into an unyielding surface. Stiff-soled shoes are going to protect the big toe joint, and well-maintained fields are generally safer to practice on than ones with unexpected holes and divots.