What Is "Turf Toe" and How Should It Be Treated

By: Ayne Furman, DPM
Fellow, AAPSM

The term "Turf Toe" is often loosely used as a diagnosis of any soft tissue type injury, acute or over- use to the big toe joint.

The big toe joint, also known as first metatarsal-phalangeal joint or 1st MTPJ is a hinge type joint that is intended to function primarily around one axis. The 1st MPTJ axis allows dorsiflexion and plantar flexion (up and down motion) of the big toe. Under the 1st MPTJ there are two small bones known as sesamoids which are embedded in a tendon that attaches to the big toe. The sesamoids function as miniature pulleys, assisting in propulsion of the 1st toe. The sesamoid bones slide forward and back as the big toe dorsiflexes and plantar flexes.

The 1st MPTJ has both propulsive and pivoting forces exerted on it during most weight bearing activities.  When ever any of these activities forcible or repetitively pushes the big toe beyond its’ normal range of motion in any direction the ligamentous structures surrounding the 1st MPTJ can be sprained. Or the sesamoid bones can slide out of postion.  This can happen during an abrupt change of direction in soccer or a tackle while playing football if the cleated foot becomes too fixed to the ground.  Synthetic turf is often sited causing more turf toe injuries because the cleated foot  “sticks” to it more than with natural grass.

Clinical evaluation of the injured area will yield information necessary to determine specific diagnosis. Most often x-ray evaluation will be performed to help rule-out a fracture or dislocation. On occasion, advanced imaging studies such as bone scan, CT scan or MRI will be employed.

Once the nature of the injury has been determined, appropriate treatment is instituted. Most frequently, rest, anti-inflammatory care, strapping and immobilization will be required. The use of spring steel insoles or more frequently, prescription foot orthotics, will often aid a return to athletics.

The goal of treatment is to return the athlete to competition, without risk of further injury. In order to do this it is necessary to understand the initial mechanism of injury and modify it if possible.

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