by Nur Elmegahed, SPT
Turf toe is an injury to the first metatarsophalangeal (MTP) joint, which is the joint at the base of the big toe. This joint helps with the toe-off phase of gait, which is when the foot prepares to take another step by pushing off the ground through the big toe.
The MTP joint withstands about:
– 50% of body weight during normal gait
– 2-3 x body weight during athletic activity
– 8 x body weight with jumping and sprinting
The MTP joint connects the toe bone (proximal phalanx) to the foot bone (metatarsal). It is surrounded by ligaments, tendons and small bones found at the distal end of the metatarsal bone called the sesamoid bones. These structures form the plantar complex, and they are affected when the big toe is moved to an unnatural position.
Mechanism of injury:
This injury is more common in athletes, and it occurs when the big toe is forced into hyperextension (towards the top of the foot past its normal range of motion), which puts the structures of the plantar complex under stress. It mostly happens after contact with another player or with the playing surface. This injury results in either a subluxation or a dislocation.
Symptoms of Turf Toe:
– Pain at the 1st MTP joint
– Bruising
– Swelling
– Tenderness
– Cramping
– Pop at the time of injury
– Pain and difficulty weight bearing
Classification:
– Grade 1: when the plantar complex is stretched => nonsurgical treatment
– Grade 2: when the plantar complex is partially torn => nonsurgical treatment, may need to immobilize the foot to allow for rest
– Grade 3: when the plantar complex is completely torn => possible surgical treatment based on the severity of the damage
How can PT help with Turf Toe?
During a PT evaluation, the physical therapist will obtain a detailed history from the patient, assess the toe’s range of motion and look at overall strength, assess for any swelling and analyze the patient’s gait pattern.
Immediately after a turf injury, it is recommended to rest, protect the area and limit movement that would cause pain, elevate the feet and use compression to decrease swelling. Physical therapy interventions include range of motion exercises to regain full great toe and foot range of motion, manual therapy to improve muscle and joint function, taping, strengthening exercises, balance training, and gait training.
References:
1- Najefi AA, Jeyaseelan L, Welck M. Turf toe: A clinical update. EFORT Open Rev. 2018;3(9):501-506. Published 2018 Sep 24. doi:10.1302/2058-5241.3.180012
2- Stanley L. Physical therapy guide to turf toe. Choose PT. https://www.choosept.com/guide/physical-therapy-guide-turf-toe. Published February 23, 2021. Accessed March 6, 2023.
3- Fraser TW, Doty JF. Turf Toe: Review of the literature and Surgical Technique. Annals of Joint. 2019;4:28-28. doi:10.21037/aoj.2019.05.03
When you need PT diagnosis, treatment and prevention in Queensbury, Malta or Saratoga Springs NY, physical therapy services at Capital Area Physical Therapy & Wellness are the ideal solution to help you live a pain-free, active life, contact us at one of our physical therapy clinics at 518-289-5242 to learn more or schedule an appointment!
