Turf toe. It may sound like nothing, but it can sideline even the strongest and toughest athlete for an entire season. I had the opportunity to speak with Joe McDermott, a certified athletic trainer at Athletico Physical Therapy, to help you understand more about this potentially debilitating injury.
Steve Green: What is turf toe and what causes it?
Joe McDermott: Turf toe is a sprain of the fibrous joint capsule that supports the metatarsophalangeal (MTP) joint at the base of the big toe. It most commonly occurs when an athlete hyperextends his big toe when pushing off the ground. Turf toe can be caused by a single traumatic event or can be the result of repetitive overuse.
What are the symptoms of turf toe?
Pain and swelling at the MTP joint of the big toe is the most common symptom. Pain commonly intensifies when an athlete tries to push off his big toe, making it difficult to perform routine activities such as running, jumping and even walking.
How common is turf toe?
Turf toe is most often seen in athletes who practice or compete on artificial surfaces, but it can occur on any surface. More frequent play on artificial turf and the growing demand for lighter shoes can further increase the risk of turf toe. As shoemakers trim weight, they often sacrifice stability and support. The shoes are increasingly flexible, allowing the big toe to move in a large range of motion.
How serious is turf toe? Can it lead to other injuries?
Like all sprains, there are varying degrees of severity. A Grade I sprain is stretch of the joint capsule, and athletes are typically able to return to play as tolerated. Grade II is a partial tear of the MTP joint tissue, typically requiring about two weeks to recover. Grade III is a complete tear of the structures of the MTP joint, requiring at least 10 to 16 weeks of recovery. Some complete ruptures require surgical repair.
Turf toe can also lead to other injuries if not properly cared for and rehabilitated. An injury causes a disruption in the way the body normally functions, and the body compensates, whether you are aware of it or not. For example, a turf toe injury can change your walking gait (i.e., your stride). The changed biomechanics may cause a number of injuries to your lower body, because everything is connected. Think of it as a domino effect.
If someone thinks he has turf toe, how and for how long should he treat it?
As with any injury, rest, ice, compression, and elevation (RICE) are critical in the early stages to decrease inflammation. Anti-inflammatory drugs also help achieve this goal. In addition, supportive and rigid footwear, such as a walking boot, can protect the toe while it recovers from the injury. There are specific tape jobs that support and protect the toe early on, but they should only be applied by a professional, because there is a risk of cutting off circulation to the area. These steps are critical for the first three to five days following the injury. From there, focus on regaining full range of motion of the toe, followed by strength and sport-specific movements.
What can I do to prevent turf toe?
Supportive footwear is the number one way to prevent turf toe. Carbon fiber shoe inserts are available that are specifically designed to support the forefoot. These are great for either injury prevention or treatment. In addition, you should follow a regular training program, always warm up before activity and focus on balanced nutrition with an emphasis on hydration.
For further reading on turf toe, McDermott recommends Sports Health, by Anderson and McCormick, and Arnheim's Principles of Athletic Training: A Competency-Based Approach, by Arnheim and Prentice. Also, check out this article from Atheltico Physical Therapy.
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