Turf toe is an injury to the ligaments under the big toe. The ligaments on the bottom of the big to at the “ball of the foot” are called the plantar plate ligaments. They provide stability to the big toe joint. This injury is more common in athletes that play on hard surfaces, like turf, but can occur in other scenarios too.
How Does Turf Toe Happen?
Turf Toe occurs when there is an injury to the big toe where the toe joint bends backwards more than it should. Sometimes, in contact sports, there is also a force from the heel that drives the toe into more flexion. For example, if someone falls on the back of the heel and pushes down on the foot while the toe is bent backwards. This type of force causes attenuation or tearing of the ligament on the bottom of the toe. There are 3 grades of injury which include: ligament sprain, partial tear or complete tear of the ligament.
Depending on the extent and acuity of the injury the symptoms may be variable but they include:
- Pain and Swelling
- Stiffness in the Big Toe
- Inability to push off when walking or running
A good history and physical exam are required to fully understand the
mechanism of injury with turf toe. On examination of the toe there may be pain
with bending of the joint, stiffness or instability of the ligaments. If an injury
occurred in the recent past there may be bruising at the base of the toe. Patients will usually walk with a painful limp because they have pain with push off.
Radiographs of both feet are often done to evaluate the injured toe and for comparison to the normal foot. Special views or angles on an x-ray with give more information and may be done. An MRI may also be ordered to evaluate the ligament, joint cartilage and tendons and may shows signs of swelling, ligament tearing or stress response in the bones.
Depending on the severity of the injury a treatment plan will be created to help alleviate pain from turf toe. Initial treatment typically includes:
- Protection – A walker boot or a stiff soled shoe is used to protect the toe joint from bending and cauasing pain or increased tearing of the ligament.
- Rest, Ice and elevation can help decrease pain and swelling
- Anti-Inflammatories will also help decrease symptoms
- Taping or Bracing – Stabilizing the toe joint will aid in alleviating symptoms and will allow the ligaments to heal appropriately.
- Physical Therapy – Therapy begins once the toe is non-painful and the toe is stable.
- Orthotic devices – Custom orthotic devices may improve the function of your foot.
Surgery is recommended when there is a complete tear of the ligament, when the injury caused a deformity or when the toe fails to improve with non-surgical treatment. Surgical intervention will be discussed in further detail with the surgeon but may include ligament repair, bone repair or excision of loose fragments in the joint.
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