Turf toe: causes, symptoms, and treatments

"Turf toe" is a term that refers to the twist (sprain) of the big toe joint. The correct medical term is hyperextension of the first metatarsophalangeal joint (MTF), since it is usually produced by excessively bending up the articular complex of the hallux.

This pathology of a physiotherapeutic nature is very common in soccer players. Sources that we will explore later estimate 5.4 turf toe events for each sporting season for some teams, which translates to 0.062 patients per 1,000 active athletes. It is estimated that those affected lose an average of 10.1 working days of sport during recovery.

If we turn our attention to professional football players, we will discover that 45% of them have suffered turf toe throughout their sports careers. If you want to know more about this pathology and how to deal with it effectively, keep reading.

The anatomy of the turf foot and toe

Before entering fully into the injury that concerns us here, it is necessary to explore the physiology of the parties involved. The human foot and ankle are true works of biomechanical art, as they have a total of 33 joints, 26 bones and more than 100 ligaments, tendons and muscle tissues.

In this case, we focus our attention on the first metatarsophalangeal joint. This is integrated into the functional and anatomical unit of the first radius of the foot, which constitutes 75% of the plantar arch. This structure is key, since its range of motion in the plane conditions the functionality of the entire foot.

The first metatarsal (the big toe) and the proximal phalanx form the metatarsophalangeal joint that is damaged in turf toe. This set performs the impulse in the final phase of the march, so it is not surprising that the pathology is evident in athletes who suffer from it.

What symptoms does turf toe produce?

The portal Orthoinfo.org shows us the typical symptoms of turf toe. As we have said, it is a lesion in the plantar complex, so the most common signs are pain when walking, intolerance to palpation of the affected area and localized swelling.

In any case, it should be noted that there are various degrees of injury, which determine the severity. These are as follows:

• I: It is a sprain in the plantar complex of the foot. It produces localized sensitivity and slight inflammation.
• II: there is a partial tear in the plantar complex. This causes more general pain and tenderness, moderate swelling, and bruising. Foot movement is painful and limited.
• III: a complete tear in the plantar complex. The injury is very painful, swollen, and heavily bruised. At this point, movement of the big toe is almost impossible.

Turf toe can develop abruptly or gradually, depending on the type of trauma. If the damage occurs gradually, the patient will worsen over time, until the clinical picture makes physical activity impossible.

To learn more: Repetitive injuries in sport: Hazard's case

Main causes of turf toe

As indicated by the portal EFORT Open Reviews, physical activities are the main cause of turf toe. In American football players, 45% of those interviewed claimed to have suffered from the problem throughout their professional careers. The incidence is estimated at 0.062 cases per 1000 athletes exposed to risk.

85% of these injuries occur on artificial grass. This is much harder than normal, so the resistance provided by the terrain probably plays an important role in the pathology.

Athletes who play other sports also suffer from the effects of this clinical event. For example, it is estimated that 0.4% of rugby players suffer from turf toe each season. This entity accounts for 11% of all foot injuries in this demanding physical activity.

Mechanism of injury

Most injuries occur by repeated contact with the playing surface or by a direct hit against another player. The events place an axial load on the first metatarsophalangeal joint, which is too extended.

The strength and atypical position of the structure cause a ligamentous injury of varying severity.

Beyond tendon damage, the sesamoid bones can also be affected. These bone structures are injured or even broken, although there are usually previous pathologies that promote this damage.

Risk factor's

As we said, playing a demanding sport on artificial turf is a clear predisposing. Anyway, beyond the field, any blow against another player (or solid element) can cause the aforementioned distension.

Here is a list of the sports considered riskier as far as this pathology is concerned. As indicated by the portal Western New York Urology Associates, are the following:

• American football or traditional soccer.
• Rugby.
• Basketball.
• Track athletics: running, jumping, hurdles.
• Dance.

Diagnostic tests

A sprained big toe joint can be suspected on physical examination. Anyway, an X-ray of the plantar bone structure is necessary, as indicated by the portal Stat Pearls. Bilateral X-rays of the foot are also important to assess sesamoid bone damage.

Magnetic resonance imaging is very helpful in quantifying damage to the sole of the foot. The clinical evidence will depend on the degree of injury and the patient's condition.

Turf finger treatment

Regardless of the degree of injury, the first step is always to apply the RICE criteria: rest, ice, compression, elevation. Translated into Spanish, this methodology is based on the following principles:

• Keep the foot free of effort and use it as little as possible: the average recovery time in athletes is about 10 days, always in the event that the injury is grade I. Those of grade II take 4 to 6 weeks to recover, while those of grade III do not begin the process until the month and a half.

• Ice: It is always advisable to place ice packs for 20 minutes, 3 or 4 times a day, on the affected area.
• Compression: To avoid inflammation and pain, the use of an elastic compression strap is usually necessary.
• Elevation: if the patient can, it is better to place the leg high, above the level of the heart.

Even grade III injuries tend to respond to conservative treatment, although recovery time is very slow. If the patient does not improve, a surgical procedure is used: an incision in the sole of the foot.

Turf toe recovery

As we said, recovery time varies from 10 days to several months, depending on the degree of damage suffered to the plant.

Furthermore, in the most severe cases the patient may never regain the initial osteoarticular structure. This results in an arthritic limb or a stiff big toe.

You may be interested: 5 habits to recover from a muscle injury

Turf finger is not serious

It is essential to inform athletes about the possible risks of practicing demanding exercises, especially if the activity is carried out on a solid surface or, failing that, there are high chances of shock.

These types of injuries are partly preventable performing exercises at the plantar level that help the structures involved to gain resistance. Footwear must also be appropriate and as soft as possible, in order to protect the sole of the foot from injury.

In any case, we must not forget that they are normal and expected events. Fortunately, they are almost never a serious problem. With a few days of rest, ice and physical therapy there is improvement after a couple of weeks.