Turf Toe

Toe Pain, Swelling, and Limited Joint Movement at the Base of the Big Toe

What could be my problem?

Turf Toe is a sprain of the main joint of the big toe that occurs when the toe is forcibly bent up into hyperextension.  In turf toe, the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx) is injured.

The joint is surrounded by important structures that hold it in place and prevent it from dislocating.  Together these structures are referred to as the “plantar complex”.

  • Plantar Plate: thick, fibrous tissue under the MTP joint prevents the big toe from bending too far (dorsiflexion)
  • Collateral ligaments:  located on each side of the big toe, collateral ligaments connect the phalanx bone to the metatarsal and prevent the toe from going too far side-to-side.
  • Flexor halluces brevis:  this tendon runs under the first metatarsal bone and attaches to the phalanx.  It provides strength and stability to the big toe during push-off motions.
  • Sesamoids:  these two small bones are enveloped in the flexor halluces tendon and help it to move more easily.  In addition, the sesamoids provide stability to the MTP joint by helping to bear weight placed on the forefoot.

“Turf Toe” refers to an injury of any soft tissue structure in the plantar complex.  These injuries can vary in severity from stretching of the soft tissue to partial tearing and even total dislocation of the MTP joint.

  • Grade 1: The plantar complex has been stretched causing pinpoint tenderness and slight swelling.
  • Grade 2: A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling and bruising. Movement of the big toe is limited and painful.
  • Grade 3: The plantar complex is completely torn causing severe tenderness, severe swelling and bruising. It is difficult and painful to move the big toe.

What causes Turf Toe? 

  • Any sport or activity when the forefoot is fixed on the ground, the heel is raised and a force pushes the big toe into hyperextension.

When to see a foot doctor about Turf Toe:

  • When Grade 1, 2 or 3 symptoms persist. (See Above)

What are my foot pain treatment options?

Non-Surgical Treatments:

Non-surgical, or conservative treatment options for turf toe normally include a combination of the following:

  • Rest
  • Cold Therapy
  • Taping
  • Non-steroidal, anti-inflammatory medications
  • Custom orthotics
  • Walking boot or cast
  • Physical therapy

Surgical Treatments:

The surgical procedure will vary according to the injury based on the podiatrists diagnoses for each individual’s condition. The surgery involves repairing the soft tissues and restore the MTP joint motion so that normal function can be preserved.

Most often recommended for Grade 3 injuries such as:

  • A severe tear of the plantar complex
  • Fracture of the sesamoid
  • Vertical instability (unusual up and down motion) of the MTP joint
  • Loose, boney chip in the joint
  • Damage to the cartilage of the joint
  • New or worsening bunion