Are there long term effects of Turf Toe?

The prognosis for Turf Toe depends on the severity of the injury. More serious injuries may require a longer time to heal and could result in a stiff toe joint or arthritis. In some cases, a full recovery may not be possible. It is important to prevent re-injury to avoid long-term issues.

How do you get Turf Toe?

Turf toe is typically caused by bending the joint of the big toe back too much, often during sports activities such as basketball, soccer, and gymnastics. It is most commonly seen in football players, especially those who play on artificial fields.

What are signs and symptoms of Turf Toe?

Signs and symptoms of Turf Toe include: - Pain and swelling in the joint of the big toe - Limping gait - Pain while walking, especially when transitioning from a flat foot to the toes - Recalling a specific incident where the big toe was forcefully extended - Swelling and bruising of the big toe joint - Difficulty in performing toe raises - Noticeable deformities like dislocation or hallux valgus/varus (sideways deviation of the big toe) - Pain points on the plantar (sole-side) aspect of the big toe joint and along the sides - Limited range of motion (ROM) in the big toe - Weakness in the muscles that flex or extend the toes - Instability of the big toe, as assessed through special testing such as the vertical Lachman test It's important to note that some cases of Turf Toe can develop gradually or chronically, requiring a thorough professional examination for proper diagnosis.

What kinds of test are needed for Turf Toe?

The types of tests needed for Turf Toe include: 1. X-rays: These are taken in different positions (anteroposterior, lateral, and axial sesamoid) to look for any signs of movement or fractures in the bones of the foot, particularly the sesamoids. 2. MRI (magnetic resonance imaging): This scan helps to assess damage to the soft tissues in the foot, such as the plantar plate and other surrounding structures. It can also evaluate the surface of the toe joint. 3. Physical examination: A physical examination is also important in diagnosing Turf Toe, as it can help assess the severity of the injury and may involve observing the movement of the sesamoid bone during the exam. These tests are used to determine the severity of the injury and guide appropriate treatment options.

What else can Turf Toe be?

The conditions that a doctor needs to rule out when diagnosing Turf Toe are: - Hallux limitus (stiff big toe joint) - Hallux rigidus (rigid big toe) - Hallux valgus (bunion) - Reverse turf toe - Soccer toe

What are the side effects when treating Turf Toe?

When treating Turf Toe, there can be several side effects or complications that may arise. These include: - Loss of strength when pushing off with the foot - Stiffness of the big toe or "hallux rigidus" - "Cock-up deformity", a condition where the toe lifts up - "Traumatic bunion deformity", a painful bump at the base of the big toe - Loose pieces of bone or cartilage in the joint space - Fibrosis in the joint, which is a buildup of tough tissue There can also be acute complications, such as: - Infections - Scar formation due to the overgrowth of tissue, known as hypertrophy - Development of a painful condition called 'plantar nerve neuroma'

What type of doctor should I see for Turf Toe?

Orthopedic doctor or podiatrist.

How is Turf Toe treated?

The treatment for Turf Toe varies depending on the severity of the injury. For mild Grade 1 injuries, basic measures like rest, applying ice, using a compression bandage, and keeping the foot elevated (RICE) are recommended. For more severe cases, a special shoe that limits motion or a controlled ankle motion boot may be beneficial. Gradually moving the foot is important once the injury is stable. Grade 2 injuries typically require around 4 to 6 weeks to recover, while Grade 3 injuries may involve immobilizing the foot in a boot or cast for 4 to 6 weeks. If conservative methods fail, surgery may be an option. Full recovery usually takes 6 to 12 months.

"Turf toe" is a sprain, stretch, or tear of a ligament in the metatarsophalangeal (MTP) joint of the big toe. It is caused by forcefully bending the big toe joint upwards too far and can cause pain and decreased agility.

Turf Toe

What is Turf Toe?

“Turf toe” is a term that was first used by Bowers and Martin in 1976 to describe a sprain, or stretch or tear of a ligament, in one specific joint of the big toe. This joint is called the metatarsophalangeal (MTP) joint. The injury usually happens when the big toe joint is forcefully bent upwards too far. If the bottom surface (the plantar plate) of the big toe gets injured, it can cause pain when you push off with your foot and make you less agile or nimble. While this type of injury can significantly impact high-level athletes, it can also cause discomfort for people in general.

What Causes Turf Toe?

Turf toe is a common injury that happens when the joint of the big toe is bent back too much. This can take place during many sports, like basketball, soccer, and gymnastics. However, it’s most frequently seen in football, especially with players who play on artificial fields, because these surfaces are harder than natural grass fields.

In the past, this injury was common on short-pile artificial turfs known as astroturf because these were even harder surfaces that put more stress on the players’ feet. Nowadays, the newer high-pile artificial turfs act more like natural grass, so this injury is not as common.

Signs and Symptoms of Turf Toe

Turf toe is a common condition where the patient experiences pain and swelling in the joint of the big toe. They might also have a limping gait and experience pain while walking, specifically when transitioning from a flat foot to the toes. It’s also possible for the patient to recall a specific incident where they forcefully extended their big toe. However, in some cases, turf toe can develop gradually or chronically, requiring a thorough professional examination to diagnose properly.

A physical examination of turf toe involves several steps:

Inspection: The doctor may observe swelling and bruising of the big toe joint. They will watch the patient’s walking pattern, looking for a limping gait and difficulty in performing toe raises. The doctor will also look for any noticeable deformities, like dislocation or hallux valgus/varus (a sideways deviation of the big toe).
Palpation: By touching the foot, the doctor can identify pain points on the plantar (sole-side) aspect of the big toe joint and along the sides. They can also compare the position of the sesamoid bone (a small, rounded bone embedded in a tendon) to the unaffected foot.
Range of Motion (ROM): The doctor will ask the patient to actively flex or extend the big toe and do the same passively to evaluate the patient’s pain and ROM.
Muscle Strength: This involves having the patient flex or extend their toes against resistance.
Special testing: The doctor might perform tests to assess the stability of the big toe, including the vertical Lachman test. This test checks the movement of the big toe compared to the rest of the foot and should be compared to the unaffected foot. For performing this test, the doctor holds the metatarsal bone and the base of the proximal phalanx (first bone of the toe), imitating a pure vertical movement at the joint.

A healthy plantar plate (ligament at the base of the toe) should prevent any vertical movement, but variations in soft tissue could make some movement normal. That’s why it’s crucial to compare it with the unaffected side while performing this test.

Testing for Turf Toe

If your doctor suspects your foot might be hurt or dislocated, they will likely start by using X-rays. These images are taken in different positions – from the front (anteroposterior), side (lateral), and bottom of your foot (axial sesamoid) while you’re standing. They will look particularly at the short, round bones underneath your foot (sesamoids) for any signs of movement or fractures. X-rays of both feet are typically taken to compare the injured foot with the healthy one. X-ray images should usually look normal, but sometimes they might show soft tissue swelling.

Often, the doctor will ask for a specific type of scan called an MRI (magnetic resonance imaging) which is done without a contrast dye. The MRI helps the doctor to see if there’s damage to the soft tissues in your foot. It can help your doctor to see if the connective tissue that helps stabilize the big toe joint (plantar plate) or other surrounding soft tissues in your foot are injured and evaluate the surface of the toe joint.

If left untreated, the injury may become long-term, leading to the big toe’s stiffness (hallux rigidus) or a misshaped big toe (traumatic bunion). In looking at the MRI images, doctors will focus on ones known as T2-weighted sequences. These images are particularly good at spotting fresh inflammation in your foot.

Treatment Options for Turf Toe

“Turf toe”, a common term for a type of foot injury, can be identified through a physical examination and imaging like an X-ray or MRI. The Anderson Classification System grades the severity of the injury from 1 to 3:

1. Grade 1: This is a mild sprain without damage to the bone or any instability in the joint. If you have this, you should still have your normal range of motion and be able to put weight on the foot.
2. Grade 2: This includes a partial tear of the plantar plate (a ligament on the bottom of the joint) or joint capsule. If you have this, you may experience pain when you move your foot, bruising, swelling, and pain when you put weight on it.
3. Grade 3: This is the most severe and includes a complete tear, leading to a loss of continuity in the the plantar plate or joint capsule. Symptoms usually include significant tenderness, decreased range of motion, swelling, bruising, and difficulty putting weight on the foot. Doctors may notice the movement of the sesamoid bone (a small bone embedded within a tendon) during the physical exam.

Treatment varies depending on the severity of the injury. The first response to most injuries includes basic measures like rest, applying ice, the use of a compression bandage, and keeping the foot elevated (often referred to as RICE). A special shoe that limits motion or a controlled ankle motion boot (a boot that controls movement of your ankle and foot) may be beneficial for more severe cases. Starting to gradually move your foot is important once the injury is stable.

Grade 1 injuries generally take about a week or two to heal before you can get back to your regular activities. Grade 2 injuries typically need around 4 to 6 weeks to recover. There might be a need for a special kind of protective taping when you go back to your regular activities. Injecting steroids or freezing agents is usually not recommended for this type of injury. Grade 3 injuries, while more severe, generally respond well to cautious treatment. This might involve immobilizing the foot in a boot or a cast for 4 to 6 weeks. Beginning gentle range of motion exercises after this period and continuing protected walking with modified shoe wear or inserts is important. Full recovery usually takes 6 to 12 months.

If conservative methods fail to bring relief, surgery is an option. There are several characteristics of injuries that might benefit from surgical intervention including a big tear of the joint capsule, misalignment or moving back of the sesamoid bones, abnormal looseness of the joint, traumatic deformation of the big toe, damage to the cartilage, a loose body within the joint, fracture of the sesamoid bone, and unsuccessful conservative treatment.

During the surgery, the surgeon will make an incision on the bottom of your foot to identify and safeguard the plantar medial digital nerve (a nerve on the bottom of the foot). They will then assess and repair any damage to the tissues, tendons, and bones of the foot. This might include stitching any tears or using suture anchors or drill holes for repairs when there isn’t enough healthy tissue to sew together. The surgeon might need to remove some damaged tissue or perform orthopedic surgery to remove any bone spurs or abnormalities in the joint. If the plantar plate or flexor tendons can’t be restored, the surgeon might also have to move the abductor hallucis muscle (a muscle in the foot) as a replacement.

After surgery, you’ll typically start gentle exercise with a physical therapist after a week to ten days. You’ll also use a removable splint or boot and avoid putting weight on your foot for about 4 weeks. After this period, you can increase your active motion and start walking with the protective boot. Usually, you’ll start wearing modified shoes after about 2 months and you can start light sport and other activities after about 3 to 4 months. You can generally expect full recovery in around 6 to 12 months.

If you have a condition known as “turf toe,” it could be mistaken for a few other conditions. The conditions that can be similar to turf toe are:

Hallux limitus (stiff big toe joint)
Hallux rigidus (rigid big toe)
Hallux valgus (bunion)
Reverse turf toe
Soccer toe

What to expect with Turf Toe

The healing time for a turf-toe injury largely depends on how severe the injury is. More serious injuries may require a longer time to heal. In some situations, a full recovery may not be possible, and the injury might result in a stiff toe joint or arthritis. In order to avoid long-term issues, it’s exceptionally important to prevent the toe from getting injured again.

Possible Complications When Diagnosed with Turf Toe

Turf toe can lead to a few different complications, such as:

Loss of strength when pushing off with the foot
Stiffness of the big toe or “hallux rigidus”
“Cock-up deformity”, a condition where the toe lifts up
“Traumatic bunion deformity”, a painful bump at the base of the big toe
Loose pieces of bone or cartilage in the joint space
Fibrosis in the joint, which is a buildup of tough tissue

There can also be acute complications, such as:

Infections
Scar formation due to the overgrowth of tissue, known as hypertrophy
Development of a painful condition called ‘plantar nerve neuroma’

Preventing Turf Toe

It’s important for patients to be aware of certain factors that can make a turf toe injury more likely. These include participating in sports on artificial turf and wearing shoes that have unusually flexible soles. Athletes should ensure that their sport shoes provide the right amount of support and are suitable for the type of surface they’ll be playing on. They should also learn to do specific exercises that increase the flexibility and strength in their ankles and feet. These exercises can help their bodies better cope with the physical demands of their sport activities.