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Turf Toe(Metatarsalphalangeal Joint Sprain; Sprain Big Toe)
Definition

Turf toe is a sprain of the base of the big toe where the big toe meets the foot. It is usually a hyperextension sprain of the first joint of the toe. A sprain is stretching or tearing of the ligaments that support a toe. Ligaments are strong bands of tissue that connect bones to each other. The injury is called turf toe because it often occurs in football and soccer players when playing on artificial turf.

Turf Toe Swelling

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Causes

Turf toe occurs when the big toe is forced to extend beyond its normal range of motion. This can be caused by:

  • Standing on the balls of your feet as another person falls onto you, causing your big toe to become hyperextend
  • Stopping suddenly when running, causing your big toe to slide into the end of your shoe and bend up and backward as you go forward
Risk Factors

Factors that increase your chances of getting turf toe include:

  • Sports such as:
    • Football
    • Soccer
    • Rugby
    • Basketball
    • Running
    • Gymnastics
    • Dancing
  • Poor coordination
  • Increased ankle dorsiflexion
  • Wearing athletic shoes with flexible soles
  • Playing sports on artificial turf
Symptoms

Symptoms include:

  • Pain and tenderness in the ball of the foot and the big toe
  • Swelling and bruising of the ball of the foot and the big toe
  • Inability to bear weight on the ball of the injured foot
  • Inability to push off on the big toe
  • Reduced range of motion in the big toe
Diagnosis

The doctor will ask about your symptoms and how you injured your toe. An exam of your toe will be done to assess the stability of the joint and the severity of the injury.

Your doctor may need pictures of your foot. This can be done with:

Treatment

Treatment includes:

Self-care
  • Rest—Do not try to run or play sports until you can walk without pain. Do not return to your sport until you can run, jump, and push off from your injured foot without pain.
  • Ice—Apply ice or a cold pack to your toe for 15 to 20 minutes. Do this 4 times a day for 2 to 3 days or until the pain goes away. Wrap the ice or cold pack in a towel. Do not apply ice directly to your skin.
  • Compression—Wrap an elastic bandage around your big toe. It is important not to cut off blood circulation to your toe or any body part when using such wraps. Do not make them very tight. Put several wraps around the big toe and then include the rest of the forefoot within the bandage. This will limit swelling and support your toe.
  • Elevation—Keep the injured foot raised above the level of your heart for 48 hours using a pillow. This will help drain fluid and reduce swelling.
  • Wear a metatarsal pad to cushion the area under the toe as directed.
  • Stiff-soled shoes or rigid orthotics—Wear stiff-soled shoes or rigid orthotic inserts in your shoes to keep your toe from hyperextending.
  • A walking boot or cast may be needed for more severe injuries.
Medication

The following drugs may help reduce inflammation and pain:

  • Ibuprofen
  • Naproxen
  • Aspirin
Surgery

Surgery is only needed to repair turf toe if:

  • A small piece of bone has been broken off by the injury to the ligament
  • A ligament is torn completely
Prevention

Often, turf toe cannot be prevented. However, to reduce your risk of getting turf toe, wear stiff-soled athletic shoes when playing sports.

Proper treatment of turf toe can help prevent long-term complications or problems with the toe joint such as misalignment and immobility.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org

American Academy of Physical Medicine and Rehabilitation
http://www.aapmr.org

CANADIAN RESOURCES:

British Columbia Podiatric Medical Association
http://www.foothealth.ca

Achilles Foot Health Centre
http://www.footdoc.ca

References:

Chou LB. Disorders of the first metatarsophalangeal joint. Phys Sportsmed . 2000;28:32-45.

Churchill SR, Donley BG. Managing injuries of the great toe. Phys Sportsmed ; 1998.

Foot sprain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 3, 2012. Accessed May 1, 2013.

Mullen JE, O'Malley MJ. Sprains—residual instability of subtalar, Lisfranc joints, and turf toe. Clinics in Sports Medicine . 2004;23(1):97-121.

Pommering TL. Ankle and foot injuries in pediatric and adult athletes. Prim Care . 2005;32(1):133-161.

Renstrom P. Sports Injuries: Basic Principles of Prevention and Care . Boston, MA: Blackwell Scientific Publications; 1993.



Last reviewed February 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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