TURF TOE
What is it?
Turf toe is a sprain of the joint where the big toe attaches to the rest of the foot known as the metatarsophalangeal (MP) joint. The injury was labeled “turf toe” because the incidence of these injuries increased with the use of artificial turf in sports. The ligaments (bands of tissue that connect bone to bone) and soft-tissue that connects that toe to the foot are stretched or torn. It can vary from a mild sprain to a severe tear of the joint capsule and ligaments. Despite its small size, injury to this joint can have long-term disabling consequences.
Anatomy
The MP joint is surrounded by many structures which may be injured with turf toe. This complex is made up of collateral ligaments, the plantar plate, and muscles (flexor hallucis brevis, adductor hallucis, and abductor hallucis). The collateral ligaments run a long each side of the MP joint and provide stability. The plantar plate is a strong fibrous band of tissue on the bottom of the toe that blends with the seasmoid bones and the flexor hallucis brevis tendon to provide stability and support to the joint. The seasmoid bones are two small round bones with-in tendons that that provide extra strength and stability to the MP joint. They are located near the MP joint in the sole of the foot. The seasmoids act in a similar fashion to the patella in the knee.
Mechanism of Injury
Turf toe can result from excessive pushing off of the big toe (hyperextension)when an athlete runs or jumps. It can also occur by jamming and bending (hyperflexion) the toe into a hard surface such as artifical turf.
Classification
The degree of injury with turf toe has been divided into three categories.
- Grade 1: This injury is a mild sprain. There is localized pain at the MP joint but there is little swelling or bruising and x-rays are normal.
- Grade 2: This sprain results in diffuse tenderness with moderate swelling, bruising, and decreased range of motion of the MP joint. This sprain is actually a partial tear of the capsule and ligament complex; however, there is no injury to the joint surface and x-rays are normal.
- Grade 3: This injury causes severe pain with a lot of swelling, bruising, and loss of motion. A complete tear of the capsule and ligament complex has occurred with compression of the joint surface. X-rays may show small flecks of bone or other fractures. This injury sometimes represents a spontaneously reduced dislocation.
Treatment
Turf toe is treated with ice, elevation, anti-inflammatories, and activity modification. Keeping the toe from bending will speed recovery and reduce symptoms. Therefore, the toe is often taped and a hard plate is placed in the athlete’s shoe to prevent bending of the toe. With a grade 3 injury, an athlete may require surgery to repair the torn tissue and remove loose bodies.
Return to Sport
The goal of rehabilitation is to return the athlete to activity as soon as is safely possible. Everyone recovers from this injury at a different rate. Returning to sport before symptoms have resolved may lengthen recovering time and cause permenant damage to the toe joint. Grade 1 turf toe can generally continue playing with stiff sole shoes. An athlete with a grade 2 injury can be expected to lose 1 to 14 days of playing time. The athlete with a grade 3 injury will lose 3 to 6 weeks of sport possibly longer if surgery is required.
Prevention
Turf toe is best prevented by wearing good shoes that fit properly and by avoiding jamming the big toe into a hard surface.