Turf Toe – How to Diagnose, Treat and & Prevent Injury
2018 Don’t get turfed out of running by turf-toe problems.
Pain in the region of your big toe? You may be dealing with Turf Toe
As an intense, full-body workout, running has many benefits over other similar exercises, such as cycling or swimming. However, the trade-off for this is that the potential for injury is much higher, due to the high intensity of running and the numerous muscles actively engaged in the running process. Much has been said about the stress running puts on your knees, hips, and shins, but one part of your body that is often overlooked when discussing injuries are your toes. This article will go over some information on turf toe: what it is, what causes it, and how to treat cases of it and prevent it from developing in the future.
What is Turf Toe?
Turf toe is a colloquial term for a condition in which the ligaments around your big toe become strained. This occurs when the toe is bent inward, known as dorsiflexion, at an angle that is too extreme. This is usually caused by excessive force being put into the movement, such as impacts from engaging in contact sports. It is most common among football players who experience pain while running on their field’s artificial turf, hence the name turf toe. However, this injury can affect any athlete that engages in repetitive foot movements, such as runners, dancers, wrestlers, and gymnasts. With excessive force put behind repetitive foot movement, a sprain is likely to occur, followed by pain, swelling and decreased mobility.
Affected Areas of the Body
The part of your foot affected by turf toe is the metatarsophalangeal joint or MTP joint. This joint connects the long foot bone, or metatarsal, to the first bone in the big toe, or phalanx. It is a primary component in the plantar complex, a group of ligaments and muscles on the lower foot that includes the plantar plate and sesamoids.
Components of the Plantar Complex:
- MTP joint, the primary joint connecting the metatarsal bone to the phalanx bone.
- Collateral ligaments that provide additional support to the MTP joint and limit the toe’s sideways movement.
- Flexor hallucis brevis, a tendon that runs under the metatarsal and phalanx, responsible for stabilizing the MTP joint.
- Plantar plate, a thick concentration of tissue under the flexor hallucis brevis tendon and MTP joint providing support and preventing dorsiflexion, or bending too far.
- Sesamoids, two weight-bearing bones embedded in the flexor hallucis brevis tendon that assist in push-off motions when running.
All of these components are necessary to proper foot movement, but the primary one affected by this condition is the MTP joint. If metatarsophalangeal joint sprain occurs, it is because the other components in the plantar complex have failed to adequately support the joint and the weight it bears. In some cases of a sprained toe, the sesamoids are also affected and can become damaged as well based on the injury’s severity.
In the case of turf toe, the symptoms are a loss of movement, pain or numbness, and swelling. In the beginning, you may only experience one or two of these symptoms, but more can develop over time. Additionally, different symptoms may occur or may be more intense, depending on the severity of the injury. If left untreated, more debilitating injuries may occur, including bone spurs, stress fractures, and dislocation.
Grades of Severity:
- Grade One is when the MTP joint is stretched past its normal point. There may be some mild swelling and tenderness, but no tearing.
- Grade Two involves partial tearing on top of metatarsophalangeal joint sprain. Symptoms are more extreme pain and swelling, as well as bruising.
- Grade Three is a complete tear of the MTP joint. In addition to extreme pain, swelling and bruising, toe movement becomes extremely difficult if not impossible.
While turf toe mainly occurs in contact sports such as football, it is possible to develop cases of a sprained toe in casual physical activity, such as running. If any of the following situations apply to you, you may be at risk for developing this condition.
- Hard Surfaces: When running on surfaces that are less pliable or shock absorbent, the likelihood of a sprained toe increases. This is where the condition gets its name: athletes running on artificial turf are far more likely to develop metatarsophalangeal joint sprains, based on the findings from a scientific study. Other than artificial turf, concrete and dirt are also potential risk factors for turf toe.
- Flexible Shoes: If the soles of your shoe aren’t firm enough, more stress is placed on your plantar complex when running. Shoes with more rigid soles are recommended for running, as they can absorb some of the shock from repeated contact with the ground.
- Prior Injury: The likelihood of turf toe increases as a result of previous foot-related injuries, such as plantar fasciitis. Any injuries that may have changed the integrity of your plantar complex or came about as a result of poor running form will increase the likelihood of turf toe.
If you begin exhibiting some of the symptoms outlined above and are exposed to some of the outlined risk factors, you may have turf toe. However, you should still seek out a medical professional in order to be accurately diagnosed. Here are some steps a doctor or physical therapist may take in order to diagnose your injury.
- Interview: A doctor will verbally interview you to gain information on your injury history, exercise habits, and symptoms.
- Physical Examination: The doctor will then examine the affected area, in this case, the big toe, and check for any abnormalities such as swelling or bruising. They may also prod certain areas of your foot to gauge your pain level.
- Testing: In the initial test process, the doctor will study the range of motion and weight bearing ability of the affected area. They may compare the hurt toe to your healthy toe.
- Imaging: This is usually only done if the doctor is convinced that the injury you are experiencing is turf toe. The doctor will then use X-rays or an MRI to study the inside of your foot, and determine the grade of severity.
When diagnosing your foot, doctors need to be thorough in order to rule out any other potential injuries. An inaccurate diagnosis could lead to ineffective and unsuccessful treatment, wasting a great deal of your time and money. Here are some other injuries that may cause foot pain similar to a sprained toe.
- Fracture: The symptoms of a broken toe or stress fracture in a toe bone are similar to those of turf toe: pain and swelling. However, this injury concerns bones rather than the connecting joint, so different treatment is required. You can find more information on stress fractures on our Runner’s Guide to Stress Fractures.
- Sesamoid Injury: If the pain is felt in the same area, but symptoms are experienced differently, the problem may be with another part of the plantar complex. Usually, there isn’t as severe of swelling, and the pain felt is milder and prone to fading away. Sesamoiditis is another bone injury, and therefore must be treated differently.
- Hammertoe: If you are experiencing pain, swelling, or deformities in toes other than your big toe, one potential cause is hammertoe. This primarily affects the smaller toes on your foot and can be caused by improper footwear or running habits. It affects joints in similar ways to turf toe, but also affects the bone structure and thus requires different treatment.
- Osteoarthritis: This is usually only experienced by older runners. If pain and swelling is felt in more areas than just the foot and is chronic rather than temporary, this is a potential culprit.
How Do You Treat Turf Toe?
Once an accurate diagnosis is made and the severity of your injury has been determined, steps can be made for treating turf toe. Many of these methods can be performed at home, but some may require the assistance of a medical professional such as a doctor or physical therapist.
Before trying anything else, you should try RICE. RICE is an acronym for Rest, Ice, Compression and Elevation. It is a standard treatment method for a wide array of injuries and is a very effective first step for treating metatarsophalangeal joint sprains. This step can be performed as soon as you feel the pain from the injury coming on; sooner even than having whatever issue you are experiencing professionally diagnosed.
- Rest: Immediately stop using the affected body part, in this case, the foot. Stop running, and stop bearing weight on the affected foot by leaning on something else or sitting down.
- Ice: Apply an ice pack to the affected area. This helps in a few ways: first, the extreme cold can apply a numbing effect that soothes pain, and second, the temperature change will compress the area it comes in contact with, reducing swelling. In order to avoid frost damage, limit ice use to 20 minutes every hour.
- Compression: Once you have rested and ice has been applied, you can start holding the affected area in a place with some sort of compression device. In the case of your feet and toes, the most effective method of compression is medical tape. For more information on applying medical or KT tape to your toe, consult the Tape section further down the article.
- Elevation: After all prior steps have been taken, keep the affected area elevated at a 45-degree angle. This step is to prevent excessive pooling of blood to the area, which will help to reduce swelling and pain. An effective and convenient way to provide elevation to your foot is to lie in a bed and prop up your injured foot with some pillows underneath your leg.
Another step to take after applying RICE is to take some form of anti-inflammatory medication. This will provide further pain and swell relief while your foot undergoes the recovery process. There are many effective non-steroidal anti-inflammatory drugs, also known as NSAIDs, that can be purchased over the counter, without a prescription. However, if these do not provide adequate relief, you may want to get a stronger medicine prescribed.
Effective NSAIDs for Turf Toe:
- Acemetacin, also known as Emflex
- Ibuprofen, commonly found in Advil
- Mefenamic acid, also known as Ponstan
- Naproxen, also known as Naprosyn
- Tiaprofenic acid, also known as Surgam
In addition to medicine, there are some foods you can eat that will provide similar anti-inflammatory effects. Making small dietary changes implementing these foods can provide short term and long term benefits to your health, so it is definitely worth considering.
Food with Anti-Inflammatory Properties:
- Olives and olive oil
- Spinach and baby spinach
- Oranges and other citrus fruits
These are medications that contain steroids, as opposed to the less severe over-the-counter NSAIDs. While used commonly to treat asthma and degenerative diseases such as arthritis, the scientifically proven anti-inflammatory effects can be effective in treating very extreme cases of a sprained toe. It is rare to use medications like these on this type of injury, but a doctor may prescribe them to you if all else fails.
Effective Corticosteroids for Turf Toe:
- Cortisone usually used to treat adrenal insufficiencies
- Dexamethasone, used for arthritis and severe allergies
- Methylprednisolone, used for arthritis and ulcerative colitis
- Prednisone, an immunosuppressant drug with anti-inflammatory properties
Whether it’s medical tape or specially designed KT Tape, taping your toes in a specific way is a simple yet effective way of treating turf toe. The benefits are three-fold: first, the movement is limited so that the metatarsophalangeal joint sprain won’t be hyperextended; second, the tape provides compression which can reduce inflammation; and third, the pain relief and light weight of the tape will allow you to continue training while wearing it, in minor cases.
Applying Tape to Treat Turf Toe, Step by Step:
- Stretch the toe backward, towards the shin, as far as comfortable.
- Take a thin piece of tape about three or four inches across, and wrap it around your big toe. Apply tension if using KT tape, but not so much that circulation is cut off.
- Take a long thin piece of tape and attach it to the underside of your foot, from the back of your heel to the base of your big toe.
- If you are not using KT tape, apply another short strip of tape around your two biggest toes to bind them together and attach to the longer strip under your foot.
For the most part, cases of turf toe don’t require surgery to be treated. Cases of surgery for the treatment of turf toe are rare and are only required for very specific circumstances. These circumstances include the development of bone spurs in the affected area, usually developed as a defense mechanism in reaction to prior injury, and partial or complete tearing of the tissue, as is the case in Grade Two or Grade Three severity cases.
Surgical Procedure for Turf Toe, Step by Step:
- Patient is administered anesthesia
- One or two small incisions are made on the side of the foot
- Any bone spurs are removed
- Any torn tissue is sewn back together
- Initial incisions are sewn back together
- A splint is attached to limit the mobility of the toe
- The leg is elevated and the patient is kept at a facility until the anesthesia wears off.
Either as an accompaniment to the surgical recovery process or as a temporary fix while relieving pain, there are a variety of orthotic devices you can use to treat cases of a sprained toe. These vary in price, effectiveness, and functionality, meaning that some will allow you to continue training while using them, and some will require you to avoid exercise while they are being used. Exercise personal judgment to determine which of these orthotics are best for your individual case of turf toe, depending on how severe it is and at what stage of recovery you are on.
- Insoles: There are specific insoles that can be placed in your running or training shoes that will help ease the pain from turf toe when walking. These are made of a hard, stiff substance such as graphite or carbon fiber, and they work by keeping the soles of your shoe rigid. Since flexible shoes are a potential cause of injury due to their lack of support, the support provided by stiff insoles will be helpful in treating turf toe for individuals who still want to train during their treatment.
- Braces/Straps: Another method of treating turf toe by preventing movement is to use a brace or strap. This will attach your big toe to the toe next to it, keeping it from bending more than what the smaller toe is capable of. These are made with a variety of materials: the braces that are made mainly of fabric will best facilitate training while using them, while thicker velcro braces will provide better support at the cost of training ability.
- Splints: These are the orthopedic devices that offer the most support, but are also so unwieldy that you will be unable to train while wearing them. Because of this, they are mainly meant to be worn at night while sleeping, but some severe cases of turf toe may require you to wear them during the day. These take the form of boots, with a great deal of padding and ventilation to provide comfort and support.
How Do You Prevent Turf Toe?
These methods of preventing turf toe are also effective in treating it. These are usually recommended by a physical therapist, but they can also be performed at home with minimal tools. Ordinarily, Grade One and Grade Two injuries won’t need much in the way of physical therapy since they can be treated fairly quickly without losing any strength in the affected muscles. However, more severe cases of a metatarsophalangeal joint sprain may require extended time of your foot, maybe in a cast, so you may need to do some strengthening and flexibility exercises in order to recover.
In all cases, performing these exercises will provide strength and flexibility that should prevent further cases from cropping up in the future. Some of these exercises will require additional materials, such as a towel, some marbles or other small round objects, and a resistance band. Be sure to check with a doctor or physical therapist before trying these, and stop immediately if you feel a sharp pain. Some of these exercises have suggestions for more intense variations; these are only recommended if you have performed these exercises comfortably a few times already, and are looking to increase the resistance.
Stretches and Strength Building Exercises for Treating Turf Toe:
- Foot Stretch: While laying down, prop one or both legs up with a pillow or foam roller so your feet have a full range of movement. Bend one foot away from your body, in a position similar to when standing on your toes. At the same time, flare out your toes by bending them backward, as far as you comfortably can. Hold for a few seconds, then reverse the position by bending your foot toward your body, and curling your toes into your foot. Hold for a few seconds, then go back to the first position. Do this movement five times with each foot, three times a day.
- Toe Pickups: Place several small round objects on the floor, such as smooth pebbles or marbles, and a bowl. While sitting in a nearby chair, curl the toes on one foot to grab one object at a time, placing them in the bowl. Do this until all objects on the ground are in the bowl, then place them back on the floor and repeat with the other foot. Do this exercise three times a day.
- Ball Rolls: While seated, place a massage ball, lacrosse ball, or similarly sized smooth ball on the ground. Place one foot on top of it, and roll the ball back and forth. Be sure to mostly use your toes, although it’s okay to use your arch a bit for this exercise. Roll the ball for 30 to 45 seconds with each foot, three times a day.
- Towel Stretch: Place a small rag or dish towel under your foot while seated. Grab the ends of the towel that aren’t under your foot. While holding the towel in place on the ground with the weight of your foot, pull the free ends of the towel toward you gently so that your toes stretch. Pull them to as far an angle as you comfortably can, then hold for up to thirty seconds and release. Do this with each foot three times a day.
- Towel Curls: Place a towel under your feet while seated on a chair. Curl the toes of both feet so that your toes are grasping the towel, then lift both legs off the ground. Hold this position for about ten seconds, then release the towel by uncurling your toes. Repeat this five to seven times, three times a day. For a higher intensity workout, try this movement with only one foot at a time.
- Resistance Toe Curl: While seated, wrap a resistance band around the big toe of one foot. Apply a small amount of tension so that your toe bends toward your body. Then, slowly curl your big toe inward. Be careful! If you apply too much resistance, this movement may be painful. Slowly return to the starting position, then repeat. Perform this exercise up to ten times with each big toe, three times a day. Don’t worry if your other toes bend with your big toe, you will still gain the effects of the exercise.
- Short Foot: While seated, start with both feet flat on the ground. Then, keeping your feet straight, lift the arch of your foot while your toes and heel stay on the ground. Hold this position for up to five seconds, then return to starting position. Perform this exercise ten to fifteen times, or until you become fatigued. For additional intensity to the workout, try performing this exercise while standing.
- Toe Spreading: While seated, keep your heels on the ground while lifting up your toes and arch slightly to allow for a full range of motion in your toes. Spread your toes apart as far as you comfortably can. Hold this position for five seconds, then relax. Perform this exercise five to seven times, three times a day.
One of the most common causes of a sprained toe is running or exercising while wearing shoes that provide an inadequate amount of support to your feet. Wearing old, worn out shoes, or casual shoes that aren’t designed for running in can cause a great deal of running injuries such as shin splints and Plantar fasciitis. In addition, wearing shoes that aren’t the right size can cause problems too: if they’re too small, your toes will be forced closer together and can exacerbate the likelihood of injury, and if they’re too large, they won’t provide adequate support. Being selective with your choice in athletic footwear can save a lot of time and money further down the line by avoiding preventable injuries.
Another common cause of turf toe is running on surfaces that are too hard. These surfaces will provide inadequate shock absorption, forcing your feet and shoes to absorb the full force of their impact with the ground. To prevent turf toe from developing, run or train on as many softer surfaces as possible. These include running tracks and natural grass. If you’re in an area lacking these surfaces, try and run on whatever surfaces are the most porous, such as asphalt road over cement sidewalk.
Surfaces to Avoid Running On:
- Artificial turf
- Hard dirt
Ideal Running Surfaces:
- Olympic-style running track
- Soft Dirt
Depending on why you run, it may be a good idea to run less often, replacing the exercise with similar high-intensity full body exercises such as swimming or cycling. This is ideal for runners interested in the cardiovascular benefits of running since you can still engage all or most of the body by performing these activities. Making a change in your workout routine may not be an option for competitive or professional runners, so instead of changing your exercise, try and take more frequent breaks. However, for athletes, bodybuilders, and casual fitness enthusiasts, it may not be a bad idea to switch up your daily exercise.
Alternative Cardio Exercises:
- Jump rope
- Weightlifting (low weight, high reps)
- Stair climbing
Diet and Supplementation
Proper nutrition is the key to health. If you wish to prevent not just turf toe, but any running injury, the best and most reliable method of doing so is ensuring your body receives the nutrients it needs through a balanced diet. Eating fresh fruits, vegetables, and fiber whole grains while avoiding saturated fats will provide a whole host of health benefits, mental and physical. For those with restrictive diets that prevent them from eating meat, gluten, or animal products, taking supplements for essential vitamins can accomplish similar results.
Nutrients Needed for Bone Health:
These are vitamins and minerals found in healthy foods that are directly linked to bone growth. If your diet is lacking in any of these nutrients, consider taking a supplement to make up for this deficiency.
- Vitamin C
- Vitamin D
- Vitamin K
- Omega-3 fatty acid
Turf toe, despite having a silly sounding name and affecting a relatively small area of the body, should be taken seriously. Improperly exercising good habits in exercise and diet can result in it developing, and it can take weeks of pain and reduced training to fully recover. The information here is to inform you about the nature of sprained toes and some suggestions on how to treat and avoid it. Despite citing medical professionals and scientific research, this should not be considered medical advice. Always go to a doctor or medical professional if you suspect that you may be injured.
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