Turf toe is an injury to the ligament at the base of the big toe. It is a painful condition which usually results from jamming of the toe into the ground or excessive backward bending of the toe. As it is more common in athletes playing on artificial turf, especially those involved in field sports such as football, baseball and soccer, it is known as turf toe.
Turf toe is usually caused by a sprain of the ligaments surrounding the big toe joint that aid in the movement of the big toe. Walking, running, jumping, dancing or any sudden movement involving a hyperextension of the big toe may cause a sprain of the surrounding ligaments and an injury to the joint capsule. This may also result in dislocation of the big toe. Another important cause of turf toe includes improper footwear which may lead to jamming or hyperextension of the big toe due to lack of friction between the foot and the surface. A stiff shoe with limited forefoot flexibility is recommended to reduce the incidence of injury.
The predominant symptom of turf toe is pain at the base of the big toe which is sudden in onset. The pain may also be associated with swelling and limitation of movement of the big toe. The joint may be predisposed to arthritis due to limitation of movement because of pain. A direct injury to the bone may result in sudden pain which exaggerates within 24 hours. If left untreated, it can result in a chronic injury.
Turf toe is a soft tissue injury diagnosed by the evaluation of presenting symptoms, history of the injury and physical examination of the injured toe joint. In some cases, X-rays or CT scan may also be used to rule out any other internal pathology.
The immediate treatment of turf toe is aimed at reduction of the swelling and inflammation of the affected joint. The RICE therapy (rest, ice, compression, elevation) can be used for the management of pain, swelling and inflammation. In addition to this, anti-inflammatory medications may also be given to relieve the symptoms. The joint may be immobilized by strapping to prevent further injury to the joint.
Surgical treatment is rarely recommended for turf toe. However, it may be considered in cases of any bone spur formation, to remove the extra growth. The plantar plate repair is required after that and the sesamoids may have to be fixed or removed. The repair of the ligaments is done using the bone anchor sutures.
Once the pain has been treated, a recurrence can be prevented by following a few simple measures which include:
- Wear shoes specifically designed for the sporting activity
- Follow physical therapy for improvement of gait and strength.
- Perform warm up exercises before any physical activity.