Turf Toe: symptoms, treatments & prevention

What causes turf toe? 

Turf toe can occur on any hard surface, but it’s most common in any sporting activity that combines artificial turf with light, flexible shoes. These light shoes don’t offer much support around the toes while the firm, artificial turf simultaneously puts more pressure on the toes.

It can be common among football players or soccer players who often compete on turf that is more rigid and less shock-absorbing than traditional grass; hence the name turf toe.

On hard artificial surfaces, the toes are more likely to be fixed or stick when you push off than with soft natural grass. Think about a sprinter getting ready to take off, with their toes on the ground and the heel of their foot raised. This motion can force the toe upward, increasing the chances of a toe sprain. The footwork involved with football, soccer, rugby, and basketball can increase your risk of developing turf toe from injury or overuse. 

Studies confirm that turf toe is the third most common injury benching college athletes, followed closely by knee and ankle injuries. Beach volleyball players, with their perplexing need to be barefoot while playing a sport, suffer the same injury—but they call it "sand toe."

Any part of the plantar complex can sustain an injury, and the severity of the trauma determines the injury level diagnosis. Stretching of the plantar complex is considered grade 1, while a partial tear is grade 2. More severe injuries are diagnosed as grade 3 and typically involve a complete tear within the plantar complex.

What are turf toe symptoms? 

Turf toe, like other sports injuries, can vary in its severity and symptoms. The mildest forms will manifest as a slight sprain, with pain in the joint along with swelling and bruising.

In more severe cases, you might hear a “popping” noise at the time of the injury. This noise could be caused by soft tissues, like the flexor hallucis longus tendon tearing or fracturing of the sesamoids—the small bones at the base of the toe to which the ligaments and tendons connect. As a result, your range of motion could be limited. The most severe cases can also involve a dislocation of the joint.

Symptoms of turf toe can include:

• Pain, usually around the ball of the foot
• Swelling
• Reduced range of motion and inability to bend the big toe
• Bruising
• Loose big toe joint
• Inability to bear weight on the injured toes or foot

A sports medicine doctor or experienced foot and ankle doctor, like those at UFAI, will conduct a physical examination and use X-rays to diagnose the extent of the damage to your toe. Depending on the severity, your healthcare provider may recommend various treatment options.

What conservative turf toe treatment options do the podiatrists at University Foot & Ankle Institute use? 

Most cases of a turf toe injury heal with conservative treatments which can include:

• Immobilization of the big toe joint in a splint or walking boot with the toe pointing down, allowing the plantar plate to heal in a stable position
• RICE (rest, ice, compression, and elevation)
• Over-the-counter anti-inflammatories, such as ibuprofen
• Physical therapy exercises to increase range of motion

If the case is mild, turf toe recovery time may only take two to three weeks with proper treatment. If parts of your plantar complex have completely torn, orthopedic surgery may be needed.

What are surgical treatments for turf toe? 

Surgery may be recommended if there is cartilage damage or bone deformity as a result of the injury or as a remedy for persistent pain and swelling. Our surgeons will choose the best surgical option based on the extent of damage to your toe or ligaments. 

If the ligaments alone are disrupted, the soft tissue can be repaired end to end with strong sutures or bone anchors. If there is a traumatic bony deformity, bone cuts may need to be made to reposition and realign the joint. If articular damage is present, our surgeon may opt to perform a cartilage transplant or perform microfracture surgery to regrow cartilage in the joint.

After turf toe surgery, the toe is usually immobilized in a cast to allow it to heal. However, this can cause stiffness in the joint. 

Fortunately, there is a new technique to reduce scarring and stiffness in the joint, known as amniotic membrane injection. The amniotic membrane has regenerative properties that reduce scarring after surgery, resulting in less stiffness after surgery.

Preventing turf toe complications 

First and foremost, after a turf toe injury, do not rush your return to sports! Turf toe is notorious for its lingering symptoms, and you don’t want a one-time sprain to turn into a chronic condition. Astoundingly, half of all athletes who sustain a turf toe injury can still feel symptoms up to five years later.

The bottom line is to try to avoid jamming the big toe into any unyielding surfaces. Wear shoes with a stiffer sole or opt for shoe inserts to help prevent the toe from forcibly bending at the MTP joint. Stiff-soled shoes and inserts can protect the big toe joint, as can taping the ball of the foot. 

Additionally, it’s best to play on well-maintained fields rather than those with unexpected holes and divots. If you can, vary your activity between hard and softer surfaces, such as turf and natural grass, to help decrease impact and trauma on the big toe joint.

UFAI is the top choice for athletes and foot injuries 

The physicians at the University Foot and Ankle Institute have decades of extensive experience in the treatment of traumas to the foot and ankle, including turf toe. They use the latest technologies available for the most accurate diagnosis and treatment possible to get you back in the game as quickly as possible. 

By offering a full spectrum of diagnostics, conservative and surgical treatment options, physical therapy, and in-office imaging, we are truly taking care of you in a state-of-the-art manner without the need to run from one location to another.

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.