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Don't Let Turf Toe Linger

Turf toe, or sprain of the first metatarsal phalangeal joint (MTP), can be one of the most painful and debilitating injuries an athlete can face. The condition was originally described in 1976 by Bowers and Martin at the University of West Virginia, where they noted an average of 5.4 turf toe injuries per season among football players.1 In 1990, Rodeo et al reported on professional football players in the National Football League2 and found that out of 80 active players, 45 percent had suffered turf toe injuries in their professional careers, with 83 percent occurring on artificial turf.

How does turf toe happen? Turf toe injuries typically occur when the foot is fixed in one position and the heel is raised with a significant amount of pressure being placed on the toes and extending them. It is thought that the combination of the hard artificial turf surface compared to natural turf, and the flexibility of shoes that is preferred by athletes, adds to injury chances. The injury to the toes can range from a slight sprain to dislocation. Swelling of the first toe joint is common for this type of injury.

How do you treat it? Conservative management, including rest, ice, compression, and elevation (RICE) should be initiated as soon as possible. Taping should be avoided in the initial stages because of swelling and the risk of compromising circulation. Antiinflammatory drugs may also help minimize pain and inflammation. A short leg cast or a walker boot may be used for the first week to help decrease pain. Gradual range of motion begins in three to five days following injury.

Grade I injuries can be treated with taping and shoe modification such as a rigid soleor insert to restrict foot motion, as soon as swelling decreases. Athletes usually can return to play quickly with little discomfort. Grade II injuries, where the toe structures are partially disrupted, typically require a boot for protection and may result in the athlete missing at least two weeks of competition. Once low impact activities can be tolerated, shoe modification should be implemented. Grade III injuries, where there is full disruption of the toe ligaments, usually results in significant loss of playing time. Individuals with this type of injury require several weeks of immobilization, followed by focusing on range of motion. As the injury heals, slow return to low impact activity and shoe modification is implemented. Surgical intervention may be required, but is usually reserved for injuries involving fracture, instability, and failed conservative treatment. Turf toe represents a significant injury that deserves adequate recognition and treatment. References 1. Bowers KD, Jr, Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports. 1976;8(2):81-83. 2. Rodeo SA, O’Brien S, Warren RF, et al. Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med. 1990;18(3):280-285.

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