Physical Therapy for Turf Toe
Turf toe is a common injury among athletes who compete on artificial turf. Turf toe occurs when the big toe is forced into extreme positions of hyperextension, causing a sprain in the main joint of the big toe. Turf toe can happen when an athlete pushes off to sprint or is tackled with the front of the foot fixed and jammed into the ground. Physical therapy is key to avert and limit stiffness in the big toe and safely heal and strengthen the injured area.
Anatomy of the Foot & Big Toe
The big toe is made up of two joints, the largest of which is the metatarsophalangeal (MTP) joint, in which the foot’s long bone (the metatarsal) meets the first bone of the toe (the phalanx). The two joints in the big toe allow the toe to move upward and bend downward. The big toe is the last joint through which the foot pushes off to move the body forward when walking and running. The MTP joint is surrounded by structures that hold the joint in place and prevent it from dislocating. These structures are called the plantar complex, which is made up of ligaments, muscle tendons, and small bones that sit under the big toe.
What is Turf Toe?
Turf toe is an injury to the MTP joint of the big toe that happens when the toe is forcibly bent up into hyperextension. This injury is particularly prevalent among athletes who compete on artificial turf as turf is harder than grass and does not provide much give when force is applied to it. Turf toe affects football players in particular, but also impacts dancers and soccer, rugby, and lacrosse players.
It is usually a sudden injury in which the athlete is tackled over a fixed foot or when the athlete pushes off, overstretching the toe into hyperextension. There are three grades of injury that measure severity. A grade one injury means the plantar complex and big toe were stretched, causing pin-point tenderness and slight swelling. A grade two injury involves a partial tearing of the plantar complex, leading to widespread tenderness, moderate swelling, bruising, and limited, painful movement. A grade three injury means the plantar complex was completely torn, resulting in severe tenderness, swelling, bruising, and great difficulty moving the toe.
Common symptoms of turf toe are:
Pain at base of big toe that intensifies when extend big toe or put pressure on it
Popping sensation at time of injury
Swelling and stiffness in big toe
Tenderness to touch
Cramping in arch of foot
Disfiguring of MTP joint if dislocated
Inability or reduced ability to move big toe
Bruising and swelling of the injured area
Alteration of gait due to pain and limited mobility of toe
Contributing factors to turf toe include:
Jamming of the foot on the ground, while the rest of the foot is pushed forward
Running and jumping on hard artificial surfaces
Wearing soft-soled shoes that provide little-to-no-protection of the forefoot
Wearing athletic shoes that do not provide adequate support when playing on turf
Repeated sprain of the big toe ligaments with enough force to result in turf toe
Body weight of the athlete
Direct injury that damages the bones of the foot and toe
Previous toe or forefoot injuries
Positioning of the body when playing sports
Ankle range of motion
Physical Therapy Treatment for Turf Toe
Physical therapy is key to avert and limit stiffness in the big toe after turf toe injury and safely heal and strengthen the injured toe. It’s important to address turf toe early on to effectively reduce the risk of long-term stiffness and pain in the toe joint. The physical therapist completes a clinical exam to assess movement of the toe and muscle function, evaluating symptoms and analyzing gait pattern. Following the evaluation, the physical therapist designs an individualized rehabilitation program specific to the athlete’s needs, goals, and sport.
Physical therapy treatment for turf toe involves:
Range-of-motion exercises to regain function and mobility in the foot and big toe, starting with gentle passive movements that are progressed to active movement as the toe heals
Taping of the big toe to reduce pain and limit motion
Muscle-strengthening exercises to restore strength and stability to the toe, including toe raises, calf raises, squats, and lunges. Cycling with proper toe support is also used to maintain fitness without straining the toe. Muscles of the leg, foot, and ankle are specifically targeted as loss of muscle strength in the leg is common due to limited weight-bearing during healing.
Manual therapy to gently move and manipulate the muscles and joints of the foot and toe to improve motion and prevent stiffness.
Balance, coordination and agility exercises, building up to gentle running, jumping, and pivoting
Sport-specific training to simulate the athletic field and practice proper technique when pushing off, pivoting, and jumping
Patient education on proper footwear for playing on turf and use of orthotics to protect the toe from future injury
To prevent turf toe, it’s critical to wear supportive and appropriate footwear when competing on artificial surfaces and avoid highly flexible soles. Performing preventative flexibility and strengthening exercises of the foot and ankle improve the foot and ankle’s ability to withstand the stresses placed on them during sports.
