The joint of the big toe is called the first metatarsophalangeal joint, and is made up of two bones; the first metatarsal bone and the proximal phalanx. The big toe is able to move up and down since the head of the first metatarsal is round, which fits into the base of the proximal phalanx; this joint is then supported by a surrounding ligament and capsule. By looking at this joint, you are obviously able to move the big toe more in the upward direction than downward direction. However, the big toe joint can be injured by forcefully moving the big toe upwards. This injury is referred to as turf toe, since it has the highest prevalence in athletes that play on artificial turf.
An example of the mechanism of injury, is a football player is in the formation squatting down in a ready to run position with the toes bent; the quarterback yells hike and the player pushes off of his toes to start running. This happens every play during every game. Turf toe has a gradual onset, since this repetitive forcing of the joint upwards, may lead to jamming, which will over time result in injury to the surrounding ligaments and capsule of the joint. Less commonly, the injury can happen quickly with one incident; for example, a football player’s cleat gets stuck in the artificial turf with their toes bent, and the player is tackled from behind. The force from the tackle will make the toe bend way past its normal range of motion leading to injury of the surrounding ligaments and capsule. Usually in this circumstance, the athlete will feel a popping or snapping at the joint, and instant pain.
Football players are not the only athletes that are at risk for turf toe, other sports that this injury is common to are: ballet, tennis, rugby, basketball, sprinting, soccer, and gymnastics.
Symptoms of turf toe include:
• Big toe pain
• Redness surrounding the 1st metatarsophalangeal joint
• Decreased range of motion, especially in bending the toe upwards
Turf toe is mostly diagnosed based on your presenting symptoms; however, the diagnosis will be easily made if the symptoms are associated with playing a sport that has a high incidence of this injury. Just to cover all bases, an x-ray will usually be ordered, to make sure that there are no signs of fractures. A quick side note, a stress fracture may not show up on x-ray for approximately 2 weeks, so at a later follow-up visit if your symptoms are not improving, another x-ray may be ordered to check for presence of a stress fracture.
Even though turf toe seems like a small injury, it can be a career ending injury for many professional athletes, such as Deion Sanders and Shaquille O’Neal.
If you are experiencing these symptoms of turf toe, consult The Platte Valley Foot and Ankle Clinic for further evaluation. By treating turf toe earlier, the likelihood of it ending your athletic career is decreased and a positive response to treatment will be more likely. A common treatment available for turf toe is custom orthoses. It will also be important to follow the RICE acronym after practice. RICE stands for: Rest, Ice, Compression, and Elevation. You may also need to take a break from playing your sport; the length of time you will need to take off of your sport will depend on the severity of your turf toe. If turf toe is not treated, it will become extremely painful and progress into arthritis in which the toe will be unable to move up or down; this is called hallux rigidus. Unfortunately, there is no treatment to reverse hallux rigidus and regain motion of the toe, which just re-emphasizes the importance of being evaluated early rather than playing through the pain.
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American Academy of Podiatric Sports Medicine