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Turf toe

Dr. Nadheer K M (AIIMS)MBBS

January 22, 2020

March 06, 2020

Turf toe
Turf toe

So, you’re "active" outside of your 40-hour work-week. Maybe you like to go for a brisk run in the morning, play a game of soccer at the local astroturf arena, or indulge in sports like basketball or badminton with the aim of keeping yourself fit. The area of indulgence notwithstanding, injuries are commonplace for someone looking to level up on the field or those who take fitness seriously.

Those who indulge in sporting activities indoors on artificial surfaces, as well as people who are used to running on the treadmill in the gym or playing sports that involve a lot of jumping, are particularly at risk of suffering from an injury called turf toe. The bottom of your big toe, also referred to as the ball of your foot (metatarsophalangeal joint), remains vulnerable to injury due to the constant pressure put on them while running, sprinting or jumping continuously.

Much like most other running injuries, turf toe is also a sprain or an inflammation of the ligaments that hold the big toe in place. A type of repetitive strain injury, turf toe also affects dancers and gymnasts; basically anyone who uses their toes to either push off repeatedly or whose routine includes a lot of jumping.

The softer astroturf (from where the injury gets its name) or an outdoor playing field are places where people suffer a turf toe, primarily due to the hyperextension of the toes while lifting off. Astroturf, a surface on which field hockey is played, was first developed in 1964, and the injuries came to light shortly thereafter.

Types of turf toe

Turf toe is further divided into grades, based on the severity of the injury:

  • Grade 1: Overstretching or hyperextension of the toe joint, causing pain and swelling.
  • Grade 2: Partial tear or inflammation of the tissues, ligaments or tendons around the toe joint that causes limited mobility and pain, along with swelling and bruises.
  • Grade 3: Any of the soft tissues in the toe joint suffer a complete tear, causing extreme pain and swelling, and no ability to put weight on the injured foot.

Turf toe symptoms

Localised pain is usually the first sign that you have suffered an injury. Here are some more signs to look out for in the case of turf toe:

  • Pain around the toe joint and difficulty putting weight on the affected toe.
  • Swelling and bruising around and under the toe joint.
  • Limited range of motion of the big toe.
  • If the injury is sustained over time, the symptoms present themselves gradually.
  • Direct injury to the bone under the cartilage, like landing on a sharp object or someone stepping on your foot, can cause stabbing pain.
  • A "pop" sensation can be felt during sudden injury, but not always.

While during a repetitive injury the signs of a turf toe emerge over time, sudden injuries can be extremely debilitating, and worsen over the next 24 hours.

Of course, prevention may be better than cure, but sports injuries usually strike unexpectedly; someone trekking in the mountains could also complain of a turf toe. You can wear all kinds of supporting equipment to prevent injury, but it is important to not ignore the first signs of pain. Visit a doctor immediately if the pain is unbearable or if it persists beyond a few days.

Causes of turf toe

While tennis elbow or golfer’s elbow injuries borrowed their names from sports that usually lead to them, turf toe gets its name presumably from the surfaces these injuries happen on.

The metatarsophalangeal (MTP) joint is held together by a combination of tissues (plantar plate), ligaments (collateral ligaments) and tendons (flexor hallucis brevis), all of which are collectively called the plantar complex.

An inflammation or a tear in any of the tissues, a tear or a dislocation of the toe joint are all referred to as turf toe injuries, further divided into three grades, with Grade 3 being the most severe.

Turf toe is usually caused by hyperextension of the big toe (first MTP) joint, either due to the surface you play or workout on, or repeated movements.

Prevention of turf toe

Turf toe can be painful to the extent that it can stop you from even standing up on your toes, let alone playing your favourite sport. Some of these tips can help you keep toe injuries at bay:

  • Stretch and strengthen your toes by performing toe lifts before going for a run or before you play a sport.
  • Wear shoes that have good cushioning as well as are toughened from the toe area, so that they do not flex all the way up.
  • Avoid wearing high heels for long durations.
  • Wear appropriate insoles and padding to provide extra support to your toes.
  • Visit a podiatrist or a physiotherapist to check your technique while you run - they can advise you on corrective measures as needed.

Diagnosis of turf toe

Injuries like turf toe usually have a sudden onset, and athletes can identify the time they sustained the injury as it usually restricts movement immediately. A sports injury specialist or an orthopaedic can properly diagnose the injury.

  • The doctor will look for physical symptoms, ask your medical history and perform a physical exam to ascertain the impact of the injury.
  • An X-ray may be recommended to determine if there is a fracture or a deformity in the joint of the toe.
  • Further imaging tests like an MRI scan may be performed for a more detailed diagnosis, in case of tears in soft tissues like tendons and ligaments, and to determine the severity of the injury.

Treatment for turf toe

Depending on the extent of the injury, a combination of immobilizing the toe, rest and rehabilitation processes have to be followed to make a full recovery.

  • The application of the RICE method - rest, ice, compression and elevation - is the first step towards dealing with injuries like a turf toe. This helps control the swelling of the injured area.
  • Over-the-counter painkillers like ibuprofen may be taken to bring down the inflammation and swelling and bring relief from the pain that is radiating from the injured foot.
  • In cases of more intense pain and discomfort, doctors may advise the use of a specially-designed boot, cast or crutches to put less pressure on the injured foot.
  • Extensive physical therapy may be required to deal with more severe injuries, coupled with long periods of rest.
  • Surgery is only recommended in the case of severe Grade 3 injuries and complicated situations. For example, surgery may be recommended for correcting tears in the plantar complex or fractures in the toe joint.

Read more: Home Remedies to Reduce Swelling Due to An Injury

Risk factors of turf toe

Some of the common risk factors of turf toe injury include:

  • Playing sports that require frequent stops and starts, changes of direction or jumping. Example, football.
  • Putting additional or extra weight of the body on the toes.
  • Constant use of high heels.
  • Wearing shoes without adequate support while playing sports or performing exercises, as they provide less stability in the forefoot.

Aggressive marketing strategies to sell extremely lightweight and flexible shoes have meant a majority of sports and fitness enthusiasts are rocking the latest versions of these shoes in their local neighbourhood games and gyms, not realising that the reduced structural rigidity of the shoe leaves the forefoot prone to hyperextension, and as a result, injury.

Takeaways for toe turf injury

Being aware of the surroundings and the playing surface, choosing the right footwear for the job and, of course, a regular regime of exercise and healthy diet go a long way in reducing the chances of injury.

Early diagnosis and treatment can help in making a full recovery from a debilitating injury like turf toe, as ignoring the symptoms can lead to further complications and chronic pain.

If you experience pain in the big toe, your doctor may advise an X-ray or MRI scan to determine the extent of the injury.

Recovery can take anywhere from a few days to a few months, depending on the severity of the toe turf injury.

While resting the injured foot and taking painkillers may be enough in some cases, others may require surgery. It is a good idea to visit a doctor in case you have a sudden onset of severe pain or if you have milder pain that lasts beyond a few days.



References

  1. Foot Health Facts [Internet]. American College of Foot and Ankle Surgeons. Chigago, IL. USA. Turf Toe
  2. OrthoInfo [Internet]. American Academy of Orthopaedic Surgeons. Rosemont, IL. USA. Turf Toe
  3. Anderson R. Turf Toe Injuries of the Hallux Metatarsophalangeal Joint. Techniques in Foot & Ankle Surgery. 2002 Dec; 1(2):102-111.
  4. Smith K and Waldrop N. Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players. Foot & Ankle International. 2018 Jun; 39(9): 1076-1081.
  5. Vopat ML et al. Return to Sport After Turf Toe Injuries: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2019 Oct; 7(10).
  6. Drakos, Mark C. et al. Plantar-Plate Disruptions: “The Severe Turf-Toe Injury.” Three Cases in Contact Athletes. Journal of Athletic Training. 2015 May; 50(5): 553-560.

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