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  • Turf Toe

    (Metatarsalphalangeal Joint Sprain; Sprain Big Toe)

    Definition

    Turf toe is a sprain of the base of the big toe where the big toe meets the foot. It is usually a hyperextension sprain of the first metatarsophalangeal joint. A sprain is stretching or tearing of the ligaments that support a toe. Ligaments are strong bands of tissue that connect bones to each other. The injury is called turf toe because it often occurs in football and soccer players when playing on artificial turf.
    Turf Toe Swelling
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    Causes

    Turf toe occurs when the big toe is forced to extend beyond its normal range of motion. This can be caused by:
    • Standing on the balls of your feet as another person falls onto you, causing your big toe to become hyperextend
    • Stopping suddenly when running, causing your big toe to slide into the end of your shoe and bend up and backward as you go forward

    Risk Factors

    Factors that increase your chances of getting turf toe include:
      Sports such as:
      • Football
      • Soccer
      • Rugby
      • Basketball
      • Running
      • Gymnastics
    • Dancing
    • Poor coordination
    • Increased ankle dorsiflexion
    • Wearing athletic shoes with flexible soles
    • Playing sports on artificial turf

    Symptoms

    Symptoms include:
    • Pain and tenderness in the ball of the foot and the big toe
    • Swelling and bruising of the ball of the foot and the big toe
    • Inability to bear weight on the ball of the injured foot
    • Inability to push off on the big toe
    • Reduced range of motion in the big toe

    Diagnosis

    The doctor will ask about your symptoms and how you injured your toe. An exam of your toe will be done to assess the stability of the joint and the severity of the injury.
    Your doctor may need pictures of your bodily structures. This can be done with:

    Treatment

    Treatment includes:

    Self-care

    • Rest—Do not try to run or play sports until you can walk without pain. Do not return to your sport until you can run, jump, and push off from your injured foot without pain.
    • Ice—Apply ice or a cold pack to your toe for 15 to 20 minutes. Do this 4 times a day for 2 to 3 days or until the pain goes away. Wrap the ice or cold pack in a towel. Do not apply ice directly to your skin.
    • Compression—Wrap an elastic bandage around your big toe. It is important not to cut off blood circulation to your toe or any body part when using such wraps. Do not make them very tight. Put several wraps around the big toe and then include the rest of the forefoot within the bandage. This will limit swelling and support your toe.
    • Elevation—Keep the injured foot raised above the level of your heart for 48 hours using a pillow. This will help drain fluid and reduce swelling.
    • Stiff-soled shoes or rigid orthotics—Wear stiff-soled shoes or rigid orthotic inserts in your shoes to keep your toe from hyperextending.

    Medication

    The following drugs may help reduce inflammation and pain:
    • Ibuprofen, such as Motrin and Advil
    • Naproxen, such as Aleve or Naprosyn
    • Acetaminophen, such as Tylenol
    • Aspirin, such as Bayer

    Surgery

    Surgery is only needed to repair turf toe if:
    Surgery is only needed to repair turf toe if:
    • A small piece of bone has been broken off by the injury to the ligament
    • A ligament is torn completely

    Prevention

    Often, turf toe cannot be prevented. However, to reduce your risk of getting turf toe, wear stiff-soled athletic shoes when playing sports.
    Proper treatment of turf toe can help prevent long-term complications or problems with the toe joint such as misalignment and immobility.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

    American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org

    CANADIAN RESOURCES

    British Columbia Podiatric Medical Association http://www.foothealth.ca

    Achilles Foot Health Centre http://www.footdoc.ca

    References

    Chou LB. Disorders of the first metatarsophalangeal joint. Phys Sportsmed . 2000;28:32-45.

    Churchill SR, Donley BG. Managing injuries of the great toe. Phys Sportsmed ; 1998.

    Foot sprain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 3, 2012. Accessed March 14, 2013.

    Mullen JE, O'Malley MJ. Sprains—residual instability of subtalar, Lisfranc joints, and turf toe. Clinics in Sports Medicine . 2004;23(1):97-121.

    Pommering TL. Ankle and foot injuries in pediatric and adult athletes. Prim Care . 2005;32(1):133-161.

    Renstrom P. Sports Injuries: Basic Principles of Prevention and Care . Boston, MA: Blackwell Scientific Publications; 1993.

    Revision Information

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