Turf Toe

with Rehab

ExitCare ImageInjury to the base of the big toe (first metatarsal phalangeal joint) that causes damage to the joint capsule and ligaments is known as turf toe. Turf toe commonly occurs on the bottom side of the joint.

SYMPTOMS

  • Pain, tenderness, inflammation and/or bruising around the big toe (contusion).

  • Pain that worsens with movement of the big toe, specifically when raising (extending) the toe.

  • Inability to walk properly on the affected foot, which causes one to limp.

CAUSES

A force being placed on the joint capsule and ligaments that is greater than they can withstand causes turf toe. Common mechanisms of injury include:

  • Repetitive and/or strenuous extension of the big toe (ie. standing on tip toes).

  • Explosive running starts (ie. sprinters).

  • "Stubbing" the big toe.

  • Another player landing on your foot.

RISK INCREASES WITH:

  • Previous toe injury.

  • Having a long first toe.

  • Flat feet.

  • Arthritis of the great toe.

  • Improperly fitted shoes or shoes that are not appropriate for a given activity.

  • Family history of foot abnormalities.

  • Activities that involve explosive running starts, standing on tip toes, or jumping.

PREVENTION

  • Wear properly fitted shoes that are appropriate for the sport or activity.

  • Protect the first toe by taping it to reduce motion.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

If treated properly, the symptoms of turf toes usually resolve with non-surgical (conservative) treatment. Occasionally surgery is necessary.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a chronic problem.

  • Inability to compete in athletics.

  • Prolonged healing time, if improperly treated or re-injured.

  • Other foot injuries that occur due to protecting the first toe from pain.

  • Loss of motion in the first toe (hallux rigidus).

  • Bunion (hallux valgus).

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. The use of range-of-motion exercises may help reduce pain with activity. It is important that you wear properly fitted shoes with a stiff sole and a wide toe box, in order to reduce the pressure on the first toe. Protecting your big toe by taping it to restrict movement may allow you to return to sports earlier without pain or discomfort. If the condition becomes chronic, then your caregiver may recommend a corticosteroid injection to help reduce inflammation. If symptoms persist despite non-surgical treatment, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Turf Toe

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Toe Extension, Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Grasp your toes and gently pull them back toward the top of your foot. You should feel a stretch on the bottom of your toes and/or foot.

  • Hold this stretch for __________ seconds.

  • Now, gently pull your toes toward the bottom of your foot. You should feel a stretch on the top of your toes and or foot.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot/ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

STRENGTHENING EXERCISES - Turf Toe

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.