Turf Toe

What is a turf toe?

A turf toe injury is a sprain of the big toe joint commonly seen in soccer and football where the big toe joint is hyper dorsiflexed as the person is attempting to kick the ball but kicks the ground instead. Contributing factors to this injury include flexible shoes and artificial turf.

Symptoms

There is usually pain, swelling, and bruising surrounding the big toe joint. You may or may not be able to bear weight. In severe cases, the big toe joint may be visibly dislocated.

Diagnosis

There may be instability of the joint on exam. X-rays will be taken initially and bilateral films are helpful for comparison. Sometimes an MRI may be required.

Treatment

Treatment depends on the severity of the injury, separated into grades I, II, and III.

 

Symptoms

Imaging

Treatment

Grade I

  • Pain
  • Mild swelling
  • Can bear weight
  • X-rays and MRI normal
  • Rest, Ice, Compression, Elevation (RICE)
  • Taping

Grade II

  • Pain
  • Moderate swelling
  • Moderate bruising
  • Pain with weightbearing
  • X-rays normal
  • MRI reveals partially torn ligaments
  • RICE
  • Taping
  • Weightbearing cast boot, usually for about 2 weeks

Grade III

  • Pain
  • Severe swelling
  • Severe bruising
  • Unable to bear weight
  • The big toe joint may be grossly dislocated
  • X-rays reveal joint subluxation or dislocation, avulsion fracture, and/or sesamoids in abnormal position
  • MRI reveals completely torn ligaments

 

  • Closed reduction
  • Nonweightbearing cast for 4-6 wks
  • Surgery

 

*Adapted from McCormick J, Anderson R. The Great Toe: Failed Turf Toe, Chronic Turf Toe, and Complicated Sesamoid Injuries. Foot Ankle Clin N Am 2009; 14: 135–150.

When is surgery indicated?

In severe turf toe injuries if the joint is grossly unstable and sesamoids are in an abnormal position, surgery may be recommended. Surgery may also be recommended if there is a fracture within the joint and/or a sesamoid fracture that is displaced.

What does surgery involve and how long is the recovery?

Surgery usually consists of repairing the ligaments of the big toe joint and addressing any associated injuries. Typically recovery incudes a nonweightbearing cast for 3 weeks followed by transition into a weightbearing cast boot for 3-4 weeks. An athlete can usually return to activity at 3 months but a full recovery takes between 6-12 months. 

 


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