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Metatarsalphalangeal joint sprain (Turf Toe)


Injury Description

Turf toe is an injury to the joint and connective tissue between the foot and one of the toes. When the big toe (1st phalange) is involved, it is known as "turf toe".[1][2]

Signs and Symptoms

Pain in the big toe area. Swelling, tenderness and pain at the joint of the big toe. Pain when bending the toe or pulling (stretching) it upwards.

Causes

Turf toe is named from the injury being associated with playing sports on rigid surfaces such as artificial turf[3]. Often, the injury occurs when someone or something falls on the back of the calf while that leg's knee and tips of the toes are touching the ground. The toe is hyperextended and thus the joint is injured. Additionally, athletic shoes with very flexible soles combined with cleats that "grab" the turf will cause overextension of the big toe. This can occur on the lesser toes as well.

A variation of "turf" toe can also happen when the nail bed is forced into the cuticle and swelling with isolated pain may occur.

It can also be caused by not cutting one's toenails properly. If toenails are sufficiently long enough that they rub on one's shoes, the metatarsal can become hyper-extended, especially when engaged in running or other physical activity.


Treatment

The injury can be debilitating for athletes who need to accelerate, quickly change direction, or jump. Use of the toes is not possible during the healing process. Since the toes are necessary for proper push-off when accelerating, those sorts of athletic activities can be almost completely curtailed. A healing period of one or more months is often required.

Because of the anatomy of the distal foot and the unique use of the foot, it is often impossible to properly tape or brace the joint. Although difficult, it is not impossible to tape the toe to limit dorsiflexion (upward bend of toe). Additionally, wearing a shoe with a rigid sole (often a metal plate) and cushioned innersole will help minimize extension of the joint. Anti-inflammatory medication as well as physical therapy is recommended.

Turf toe can often progress into a chronic problem, in which the joint(s) never really heals or heals too slowly to return to usual physical activities.

Turf toe can become more serious if left untreated, and may cause serious problems for the athlete.

References