Football fans everywhere should be at least familiar with turf toe injuries, even if they’re not exactly sure what it means. It’s quite common in that sport, especially for skill position players—a turf toe injury knocked RB Johnathan Davis out of the last two games of the Longhorns’ 2015 season, for example.

Despite the name and common association with football, the truth is that turf toe injuries can happen to athletes of all ages, ability levels, and on any surface—not just artificial turf. And if one happens to you, you’ll want our expert care.

What Is Turf Toe?

The simplest explanation: turf toe is a sprain of the joint at the base of your big toe—the metatarsophalangeal joint, in doctorspeak. As with a sprain of any other joint (such as the ankle), turf toe involves tearing and damage to one or more of the ligaments that support and protect the joint, keeping the bones properly aligned.

The most common symptoms include pain, swelling, tenderness, and severely limited flexibility and range of motion in the affected toe. Upon evaluation, turf toe injuries are usually classified as a grade 1 (some ligament stretching and tenderness), grade 2 (some ligament tearing, moderate swelling, pain, and bruising), or grade 3 (extensive tearing, pain, and bruising).

Causes and Risk Factors

The most common cause of turf toe is an acute hyperextension of the big toe. These sorts of situations may crop up in sports that require a lot of running, jumping, or “cutting” motions—the front of your shoe or cleat grips the ground, the heel rises, and an excessive force (a push off, a tackle, etc.) flexes the toe further than it’s designed to go. However, turf toe can also appear as an overuse injury, where instead of a single sudden trauma, repetitive smaller forces damage the ligaments over time.

It is true that turf toe is especially common among athletes who play on artificial turf, particularly older surfaces. There are a number of reasons for this—the ground is harder and less forgiving than natural grass, cleats are more likely to stick in them, and the type of footwear used in turf sports generally don’t provide much support or stability in the forefoot area. While this helps make players more agile, it doesn’t offer much protection.

However, while artificial turf magnifies the risk, it’s far from a prerequisite. Whatever your sport (running, soccer, basketball, tennis …) or surface (turf, grass, wood, dirt, asphalt …), you’re at risk in any activity that could involve hyperextension of the toe through running and jumping.

Treating Turf Toe

Turf toe is often treated conservatively, especially for milder sprains. At home, you can employ the RICE protocol to good effect. RICE stands for rest (cease the activity that caused the injury and avoiding bearing weight on the injury as much as possible), ice (15-20 minutes at a time, once per hour as needed), compression (using an elastic wrap), and elevation (above heart level, ideally).

More serious injuries (grade 2 and above) may require further professional care. We often recommend a special walking boot for a week or so in order to protect the toe and keep the joint fully immobilized so that unobstructed healing may take place. This may be followed (or in milder injuries, replaced by) simple “buddy taping” strategies that use the stability of a neighboring toe to restrict motion of the injured toe. Other conservative tools include shoe inserts and OTC anti-inflammatory medications.

If we feel it’s necessary, we may order X-rays or other tests to obtain a clear picture of the tissue damage you’re dealing with and rule out fractures or other problems with muscles or bones. Surgery is rarely necessary for turf toe, but may be considered for severe grade 3 sprains, especially if there are injuries to cartilage, bone chips in the joint, fractures in the sesamoid bones, or other complicating problems.

We know how important it is for you to get back in the game, healthy and ready to play—whether your home is the gridiron or elsewhere. Call Dr. Keith McSpadden at North Austin Foot and Ankle Clinic today to schedule your appointment. You can reach us at 512-593-2949.