Condition Spotlight: Turf Toe

diagram of foot showing where turf toe affects

Do you get pain in your big toe?

Does it feel like the joint of your toe is jamming or being locked up?

If so, you might have turf toe!

This type of injury is named because of its high prevalence in sports played on grass or turf surfaces. Athletes such as Patrick Mahomes (NFL), Tom Brady (NFL), and Aaron Sandilands (AFL) have all suffered with turf toes injuries and recovered!


What is turf toe?

Before we dive into turf toe causes and treatment, we need to understand the joints involved and mechanics of the injury.

The big toe joint is made up of the end of the long bone of your foot, called the metatarsals, and the first bone of the big toes, known as the phalanx. This can be seen in the image above.

The structures within this joint allow it to move and help to protect the joint from being damaged.

In a turf toe injury, damage occurs to the joint itself and can be graded according to severity of the injury.


What does turf toe feel like?

Turf toe injuries are described as having pain directly in the big toe joint that can be sharp, throbbing, or even an ache.

People often described experiencing a ‘poop’ in the big toe area. In addition to this, they are unable to push off the ground when running or walking, due to a ‘jammed’ or ‘locked up’ feeling within the joint.

The big toe can appear to be swollen or bruised, with tenderness present on passive movement of the joint.


What causes turf toe?

Turf toe injuries involve hyperextension of the big toe joint.

This occurs when the big toe stays in contact with the ground as the foot and body continue to move forward.

This action places a high degree of load through the big toe joint and can lead to injury.

Movement of this type is more pronounced in sports with tackling, as extra force and weight is often placed on the big toe.


Who does turf toe affect?

Turf toe is frequently seen amongst the following people who participate in the following sports:

  • AFL
  • Dancing
  • Soccer
  • American Football
  • Ballet
  • Netball
  • Basketball

The reason that this form of injury is common in these sports is because of the explosive movements and hard surfaces.  More recently, sports like AFL and soccer are being played on artificial turf, which is leading to a spike of turf toe related injuries. The reason for this is that artificial grass surfaces are harder than standard grass.

Footwear can also be a contributing factor in a turf toe injury. Wearing shoes that place an increased amount of force through the big toe, such as heels or unsupportive runners can often be the cause. Boots with spikes, cleats, or studs can become stuck in the ground whilst the toe is placed into hyperextension, leading to further damage of the big toe joint.


How is turf toe diagnosed?

When diagnosing turf toe our team here at Watsonia Podiatry will ensure that you receive an accurate diagnosis and understand your injury.

Understanding the sports played, your footwear, pain levels, and a history of injuries is the first step in diagnosing your injury.

The reason for our thorough history taking is that pain in the big toe can also be due to a variety of other conditions, including:

Looking at your shoes is a great way to check for areas of high pressure. This can be done at home by taking the insole out of your shoes and checking the sole of the shoe for any noticeable loss of tread and wear.

As podiatrists, we will check the following:

  • We will look for any noticeable swelling or bruising of the big toe
  • We assess the range of motion in your big toe by moving it manually through its full range of motion
  • We will look at the way you walk on our treadmill

We may also send for x-rays, an ultrasound, or sometimes, MRI imaging to accurately determine the cause of the injury and to rule out any fractures.

Turf toe injuries can also be graded depending on the severity of the injury. The characteristics of these grades include:

  • Local swelling
  • Bruising
  • Mild pain with movement
  • Moderate swelling
  • Imaging shows tear of surrounding structures
  • Limited movement of joint
  • Large degrees of swelling
  • Images show high amount of damage
  • Weakness of the big toe
  • Limping and trying not to weight bear on the toe.

How is turf toe treated?

Treating turf toe is largely dependent on the grade of injury:

Grade 1 injuries

If you’ve just finished dancing or playing footy and your toe is sore, following the RICE procedure of rest, ice, compression, and elevation can assist with your pain.

Keeping off the toe as much as possible in this time to allow for healing is critical to ongoing pain relief.

In the next few days, taping the toe in a downwards position can help in restricting movement to assist with healing.

Gentle toe range of motion exercises and wearing flatter  shoes with a stiff sole is recommended.


Grade 2 injuries

This pain is usually always apparent after sport or at the end of the day and the RICE treatment only provides some relief.

It is recommended that at least 2 weeks is taken off from sport and the toe fixed in a downward position using taping, whilst also wearing stiff soled shoes.

Exercises to strengthen the toe will be used in this grade of injury. Some of these exercises include scrunching your toes and using a Theraband to push the big toe down. These simple exercises will be prescribed before you are able to progress into jogging and running.

At this stage, orthotics may be suggested to address foot function and facilitate efficient movement through the big toe.


Grade 3 injuries

In this stage, a minimum of 8 weeks away from sports is needed and the foot will be placed in a Moon boot with the toe fixed into a downwards position.

During this time, the rehab will progress through grade 2 and grade 1 recommendations.

A grade 3 turf toe injury that cannot be managed with conservative treatment or is restricting your ability to return back to sport may require surgical intervention, though this is not common for this type of injury.


If you have experienced a turf toe injury, or any pain or discomfort in your feet and/or lower limbs, come see us at Watsonia Podiatry today.  You can book your appointment with us online here or by calling us on (03) 9432 2689.


Aaron Dri