A Turf toe is an injury to the great toe joint. It occurs when the great toe is forced upward such as may occur when an athlete cuts hard on artificial turf. With too much upward force on the great toe the soft-tissues (capsule) lining the base of the great toe joint is injured or in some instances completely torn. This leads to pain and swelling in the toe. Treatment for partial tears of the capsule includes rest, ice, avoiding aggravating activities, taping or shoes to limit movement. The recovery can be prolonged — often for as long as 2-8 weeks or more. Complete ruptures of the capsule require surgery and a prolonged recovery of 4-6 months.
Turf toe injuries result in pain at the base of the great toe. They usually occur after an acute injury although repetitive forced upward movement of the great toe may also lead to an injury of the tissue (capsule) stabilizing the great toe joint. Turf toe is commonly seen in contact sports such as football, soccer, and rugby. It can also occur in high impact sports such as gymnastics and dance. Commonly an athlete will be changing direction suddenly on the playing field and the great toe will be forced upwards as the foot rolls over the toe which is planted on the ground. With enough force the soft-tissues (capsule) on the under surface of the great toe will be torn either partially or completely. Patients will complain of pain in the great toe, noticeable swelling, a limp, and an inability to run on the foot.
Patients with turf toe injuries will have pain in the great toe region especially at the base of the toe in the sole of the foot (plantar surface). The great toe will often be swollen. Moving the great toe upwards will often create pain. If the capsule is significantly torn the great toe joint may be noted to be unstable. A noticeable limp may be observed as patients try not to load the injured area of their foot.
Plain x-rays should be reviewed to rule out other injuries such as sesamoid fractures and other fractures involving the great toe. However, x-rays in turf toe injuries are usually negative.
A stress x-ray or fluoroscopy may demonstrate excessive movement (instability) of the great toe joint when the great toe joint is stressed.
An MRI will reveal evidence of the soft-tissue (capsular) injury.
A classification system has been presented by Clanton et al in 2007
Grade 1: Attenuation of the plantar soft-tissue (capsule) of the great toe
Grade 2: Partial tear of the plantar soft-tissue of the great toe
Grade 3: Complete tear with instability of the plantar soft-tissue
Non-operative treatment is usually effective for grade 1 and 2 turf toe injuries (partial tearing). The principles of treatment are to limit great toe movement while healing occurs and to control the symptoms of pain. Common non-operative treatment includes:
In Turf toe injuries where there is complete tearing of the plantar soft-tissues of the great toe surgical repair may be needed. As well some turf toe injures that do not adequately recover may benefit from turf toe surgery.
The surgery involves:
It is not uncommon for swelling to persist for many months. It is also not uncommon to have some residual symptoms even after a seemingly successful surgery. Unfortunately for some a severe turf toe injury could be a career ending injury.
The following general complications can occur: