Turf toe might have a funny name, but it can bring some serious pain to its victim. If you’re playing sports, the last thing you want to hear is that you or another member of your team has sprained a foot. Turf toe can keep you from playing at your best (or playing at all) and can take time to help if not properly treated. Are you doing everything you need to do to prevent and treat turf toe? Read on to find out.

What Is Turf Toe?

This condition is called “turf toe” because it is common among American football players, especially with the advent of artificial turf, which has less give than traditional natural turf. Coupled with the soft shoes players wear that enable greater agility plus high-impact tackles, turf toe is a frequent occurrence.

The strain happens to the joints or ligaments under the ball of your foot, directly behind the big toe. When the foot is hyperextended and then remains flat while the rest of the body continues forward (such as when the shoe gets stuck on turf or when a player is tackled), that area can become damaged.

To fully understanding what’s happening in your foot (and how to prevent it from happening at all), let’s take a closer look at your body’s anatomy.

Foot & Toe Anatomy

This condition is called “turf toe” because it is common among American football players, especially with the advent of artificial turf, which has less give than traditional natural turf. Coupled with the soft shoes players wear that enable greater agility plus high-impact tackles, turf toe is a frequent occurrence.

The strain happens to the joints or ligaments under the ball of your foot, directly behind the big toe. When the foot is hyperextended and then remains flat while the rest of the body continues forward (such as when the shoe gets stuck on turf or when a player is tackled), that area can become damaged.

To fully understanding what’s happening in your foot (and how to prevent it from happening at all), let’s take a closer look at your body’s anatomy.

How Do I Know If I Have Turf Toe?

There are two types of sprains you can experience: a direct and sudden injury or a gradual wearing down or worsening of your support structures. If you experience the former, you will probably encounter worsening and possibly even severe pain within the first 24 hours. You might experience loss of mobility and find that your foot becomes very painful to walk on.

The latter is less common, but if it occurs you might find walking to become gradually more uncomfortable and the pain in your foot to increase as time goes on.

Ultimately the term “turf toe” will apply to any injury in the plantar complex, including soft tissue tears or bone injuries. Since the severity of injury can vary quite dramatically, medical professionals use three treatments grades: Grade 1, Grade 2, and Grade 3. Here is how the grades are assessed:

  • Grade 1 includes stretching of the plantar complex so that there is pin-point tenderness and slight swelling. Pain is usually mild.
  • Grade 2 injury is more widespread and involves greater amounts of tenderness, swelling, and possibly even bruising. What’s especially pronounced is that movement of the big toe will be limited and painful.
  • Grade 3 injury is extremely painful and involves very limited mobility of the big toe. Severe tenderness, swelling, bruising, and pain will be present.
  • First Aid for Turf Toe Injuries

    If you think you’ve injured your foot, the best protocol is to immediately apply first aid. You can use the word “RICE” as a helpful acronym to help you remember which steps to take: rest, ice, compress, and elevate.

  • Rest your foot immediately after injury and for up to 48 hours after. It can be difficult, but using an injured foot will only prolong the healing time. If necessary, you can use crutches, tape your foot with athletic tape, or use a turf toe brace or shoe with a very stiff sole that will not allow your foot to flex.
  • Ice your injury. You should never apply ice directly to your skin, but do ice down your foot for 15-20 minutes every two hours in the first day or two. This will help reduce swelling and inflammation and decrease pain or discomfort.
  • Compression. Either with tape or with a sock, compression will help with healing, pain, and circulation.
  • Elevate your foot by propping it up. This will help remind you to rest, as well!
  • Seeking Help From the Professionals

    Minor pain or swelling that gets better after first aid treatment might not require you to seek help from an orthopedist or physical therapist, but doing so can help you speed up your recovery time, make sure you don’t worsen your injury and get back to playing as soon as possible.

    Your doctor may recommend ibuprofen or other medication to reduce pain and inflammation and may tape or strap your big toe to the toe next to it to relieve stress. He or she may also provide you with a boot or crutches and in severe cases, may refer you to a surgeon for surgical intervention. Here’s a more detailed breakdown of what to expect when you see a professional:

    Establishing the Injury

    As in any appointment, your health professional must first establish a basic health standard for you and will ask questions about previous injuries. She will also ask specific questions about your sprained big toe to try to determine how it happened, the circumstances around it, and how severe it might be. She or he will also physically examine your foot to check for swelling.

    Most likely, there will also be an exam to determine the range of motion, one of the most telling signs of severe damage. Your doctor will bend your toe in all different directions and will compare your injured foot and toe to your healthy foot and toe. Since this might be a painful process, it might be necessary to discuss numbing your foot before the range-of-motion tests.

    Your doctor might also request imaging tests, such as an x-ray or MRI. An x-ray will provide your therapist or orthopedist with clear images of the dense bone structures in your foot. If there is a bone fracture, dislocation, or movement of the sesamoid bones, this test will help determine the extent of the damage. An MRI (magnetic resonance imaging) does a better job creating images of soft tissue and cartilage injuries and is often required in Grade 2 or 3 injuries that aren’t visible on an x-ray.

    Treating the Injury Without Surgery

    Only very severe injuries will require surgery, but there is a likelihood that you’ll be referred to a physical therapist (PT). A PT can not only help your body heal to pre-injury norms more quickly but can also help you learn to move so that you do not re-injure the same tendons (or similar structures). Typically, the pain in your foot will resolve in about two to three weeks, in which case physical therapy can also help to bring mobility to the immobilized joint ends again.

    You can usually expect your turf toe injury to heal well, especially if you address it early and seek help. Common complications, however, include pain and joint stiffness that range from mild to moderate, as well as a bunion, lack of strength during the push-off stage of walking, and cocking up of your large toe.

    Surgical Treatment

    Severe Grade 3 injuries do sometimes require surgical intervention, particularly if you are an athlete at a high level and do not want your activity compromised in any way. Severe tears in the plantar complex, sesamoid fractures, vertical instability of the MTP joint, floating bone chips, damaged cartilage, and a new or worsening bunion can all require surgery. The surgery itself will vary quite a bit, depending on your injury and overall health.

    Preventing Turf Toe

    Severe Grade 3 injuries do sometimes require surgical intervention, particularly if you are an athlete at a high level and do not want your activity compromised in any way. Severe tears in the plantar complex, sesamoid fractures, vertical instability of the MTP joint, floating bone chips, damaged cartilage, and a new or worsening bunion can all require surgery. The surgery itself will vary quite a bit, depending on your injury and overall health.

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