FOOT & ANKLE

Turf Toe

The big toe is made up of two joints, the largest is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). Turf toe is an injury to the ligament at the base of the big toe or injury to the MTP joint. Turf toe is a painful condition which usually results from jamming of the toe into the ground or excessive backward bending of the toe. It is known as turf toe as it is more common in athletes playing on artificial turf, especially those involved in field sports such as football, baseball and soccer.

Symptoms

The most common symptom of turf toe is sudden onset pain at the base of the big toe. Swelling and limited movement of the big toe may also be experienced. Following injury the joint may be predisposed to arthritis due to limitation of movement as a result of pain. A direct injury to the bone may result in sudden pain which exaggerates within 24 hours. If left untreated, it can result in a chronic injury.



Causes

Turf toe is usually caused by a sprain of the ligaments surrounding the big toe joint that aid in the movement of the big toe. Walking, running, jumping, dancing or any sudden movement involving a hyperextension of the big toe may cause a sprain of the surrounding ligaments and an injury to the joint capsule. This may also result in dislocation of the big toe. Another cause of turf toe includes improper footwear which may lead to jamming or hyperextension of the big toe due to lack of friction between the foot and the surface. A stiff shoe with limited forefoot flexibility is recommended to reduce the incidence of injury.

Diagnosis

Turf toe is a soft tissue injury, diagnosis is made by medical consultation and examination, taking the patient's past medical history and physically inspecting the injured area. An X-ray or CT may be taken to rule out any other internal pathology.



Treatment Options

Non Operative Treatment

Most cases of turf toe are treated non operatively. Immediate treatment goals are to reduce swelling and inflammation of the affected joint. R.I.C.E. therapy (rest, ice, compression, elevation) can be used to manage pain, swelling and inflammation. In addition to this, anti-inflammatory medications may also be given to relieve the symptoms. The joint may be immobilised by strapping to prevent further injury to the joint.


Surgery

Surgical treatment is rarely recommended for turf toe. However, it may be considered in cases of any bone spur formation, to remove the extra growth. The aim of surgery is to repair the soft tissues and restore MTP joint motion to preserve normal function.

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