Turf toe is a term that sends shivers to athletes, footballers, or even ballerinas. The term refers to a sprain of the ligaments around the joint of the big toe. While many footballers suffer from turf toe, athletes in other sports like gymnastics, wrestling, basketball, and dancing also suffer from the condition. The primary turf toe cause is jamming the big toe or repeatedly pushing off the big toe when jumping or running.
Treating turf toe is intensive and needs time. You want to consult a highly-trained, experienced physical therapist because your career and livelihood could be highly dependent on your big toe. At Suarez Physical Therapy, we have treated many turf toe patients in Las Vegas, NV. Our non-invasive methods will have you recuperate fast and proceed with your career. This article teaches what causes turf toe, its diagnosis, treatment options, and how to prevent the condition to stay in the game.
What Is Turf Toe?
Turf toe refers to an injury to the underside and joint at the base of your big toe. Basically, the turf toe is a hyperextension of your big toe. When this joint sprains, you could have damages to your tendons, ligaments, bone, or all of these at a go.
Your big toe has two joints. The joints allow your toe to flex downward and extend upward and give you the ability to move. When your foot touches the ground to enable the other foot to take a step, your big toe is the last joint through which the foot pushes off the ground to move the body forward. The MTP is the primary joint involved in this motion. This joint The first metatarsophalangeal (MTP) joint is referred to as the ‘ball of the foot.’
The Big Toe Anatomy
As stated above, the big toe has two joints. The bigger joint is known as the metatarsophalangeal joint (MTP). At the MTP, the metatarsal, the first long bone of the foot, meets the phalanx, the first bone of the toe. When you suffer from turf toe, the injured part is the MTP joint.
Various structures, the plantar complex, hold the MTP in place to prevent dislocation. Elements of the plantar complex are:
- Plantar plate. A dense and fibrous tissue beneath the MTP joint. The joint prevents the big toe from dorsiflexion, which is the bending upward of the big toe.
- Collateral ligaments. These ligaments are on each side of the big toe. They join the phalanx to the metatarsal and prevent the toe extending too far.
- Flexor hallucis brevis. A tendon beneath the metatarsal. It connects to the proximal phalanx to offer strength and stability to the big toe during movements.
- Sesamoids are two small bones enclosed in the flexor hallucis tendon. The bones help in movement. Also, these bones offer support to the MTP by holding the weight put on the front of the foot.
What Causes Turf Toe?
Turf toe occurs when your big toe is bent at an angle of 90 degrees and pressed flat against the ground. Normally, the heel is off the ground, similar to a sprinter’s starting position. If you place a lot of force on your big toe, you could hyperextend it. Beginning your big toe farther than it is supposed to go could cause soft tissues, tendons, and ligaments in the joint to tear or stretch.
Causes of turf toe could involve trauma, for instance, when a fellow football player tackles you when your big toe is planted on the ground. Athletes who make sudden foot movements and change direction are susceptible to turf toe. Other turf toe causes are:
- Soft-soled footwear. Modern-day footwear is lightweight and flexible. The footwear offers very little support at the front of the foot.
- Artificial surfaces. The appearance of artificial turf caused many MTP joint injuries in the 1960s. Per credible statistics, 50% of athletes suffered from turf toe, and out of these, 85% occurred on artificial turf.
- Sporting activities. Football players are known to be the most affected persons. Turf toe is also common in lacrosse, dancing, field hockey, soccer, and basketball.
Symptoms and Signs
The most common symptoms of turf toe are:
- Limited joint movement.
- Joint that feels loose.
- Swelling and bruising.
- Pain at tenderness.
- Cramping in the arch of the foot.
These symptoms become worse slowly and gradually if you incur repetitive injuries. If a sudden forceful motion causes the injury, you could feel the pain that worsens in 24 hours. At times you could feel a ‘pop’ when the injury happens. Normally, the whole joint could be involved, thus limiting the toe movement.
How Turf Toe is Diagnosed
To diagnose turf toe, your physical therapist uses a systematic approach, including:
- Examine your big toe and gently push on the injured region to check for tenderness. The physician coils ask you to move your big toe to check your range of motion.
- Checking for bones and soft tissue damage using an X-ray or Magnetic Resonance Imaging (MRI) scans. The tests show images of soft tissues, tendons, and bones.
- X-rays show images of dense structures like your bones. Even if the plantar complex comprises soft tissues, the x-ray could be used to show if you have other issues in your toe.
- MRI scans provide clearer pictures of soft tissue than X-rays. If you sustain an acute turf toe, your therapist could use an MRI scan or when X-rays cannot reveal the abnormalities.
- Asking you how the turf toe occurred. You want to share as many details as you can recall.
How Can a Physical Therapist Help?
You want to seek help from your therapist the moment you suffer a turf toe injury. Your physician could use various tactics to help ease your pain and lower the risk of sustaining a turf toe injury soon. These tactics include protecting, elevating, avoiding anti-inflammatories, compressing, and educating (P.E.A.C.E).
- Your physician could advise that you limit movement.
- Your physician could place your feet up above the heart level.
- Avoid anti-inflammatories. Immediately after sustaining an injury, the region becomes inflamed as a natural healing process.
- The physician places pressure on the affected region to reduce swelling.
- Lastly, your physician could educate you concerning the injury and advise you on an ideal recovery approach and treatment. Your physician could advise on the most appropriate time to return to your athletics.
The physician could use another approach known as L.O.V.E, depending on your injury extent. The approach involves:
- The human body needs a particular stress amount to stimulate the healing process. Your therapist should work with you to know how much stress you can place on your big toe and determine the right stage to do so.
- Despite sustaining injuries, you should remain positive.
- Certain aerobic and cardiovascular exercises that do not place so much pressure on your toe joint could help you:
- Reduce pain.
- Improve blood flow to the affected area.
- Stay motivated and optimistic throughout the recovery period.
- The pain you experience should be your guide to return to your pre-injury state. Your therapist will design a treatment plan with particular and targeted exercises for your condition.
What Kind of Physical Therapist Do I Need?
Through education and clinical experience, all therapists are prepared to handle various conditions and injuries. However, you want to consider a physician who has many years of experience treating patients with musculoskeletal or orthopedic injuries when it comes to turf toe. You also want to use a specialist who is certified to offer sports physical therapy. They will have advanced knowledge, experience, and skills that you seek.
When looking for the ideal physical therapist, you could use the following tips:
- Look for recommendations from friends, family, and health care practitioners you know.
- When contacting a therapist, ask about their experience with handing turf toe before scheduling an appointment.
- During the initial clinic visit, describe how you feel and what happened in detail. Tell the physician about the activities that worsen your symptoms.
Turf Toe Treatment and Management
Treating turf toe at early stages is important. Early medication speeds up the healing process and reduces your symptoms. If you ignore your injury, it could cause a challenging treatment process, edema, and prolonged inflexibility. Also, if you are an athlete, you might not partake in an athletic competition after suffering from a turf toe.
Non-surgical Turf Toe Treatment
Different nonsurgical treatment options for turf toe exist depending on the injury grade. The injury grades are:
- Grade 1. The soft tissue is stretched but not torn. The injured region is sensitive to touch. It could have mild swelling, and you could have mild limitations with sporting activities.
Treatment options for a grade 1 injury include:
- Rest, Ice, Compression, and Elevation (R.I.C.E) Protocol. The R.I.C.E treatment option comprises four practices that you should consider doing two or three days after injury. Therapists recommend icing the injured area at least thrice a day for 30 minutes.
- Rest. Resting is vital for the healing process. Therapists call the resting stage ‘relative resting.’ you are advised to avoid activities that could stress the injured region to the extent of pain. Extensive pain-causing activities could slow healing.
- Ice. Also known as cryotherapy, it uses cold treatments to treat acute injuries. Therapists recommend ice to minimize swelling and pain. You could perform cryotherapy at home by placing a bag of crushed ice over a paper towel on the affected region. Ice the injured area for 1 to 2 hours at intervals of about 15 minutes.
- The Compression approach involves wrapping the affected area using an elastic bandage to apply pressure on the region. You reduce swelling and provide mild support through compression.
- Elevation. Elevation helps avoid filling of fluid in the injured joint. You position the injured region above your heart level.
- Nonsteroidal Anti-Inflammatory Medicines. These medications lower pain and swelling.
- Toe Protection. Orthotics offer support and decrease stress to the plantar complex. Therapists advise athletes to use footwear that comprises turf toe plates, which are rigid carbon graphite inserts. The plate restricts the big toe movement. Also, depending on injury severity, you could wear custom-made orthotics with Morton’s extension, a carbon graphite orthotic that extends under the metatarsophalangeal joint (MTP).
- Immobilization. There are conflicting opinions concerning taping the big toe to smaller toes. The approach could decrease motion on the big toe, but it could also hinder blood circulation because of swelling after sustaining a serious injury. You could use a walking boot to reduce ankle movement for one to two weeks after sustaining the injury.
- Range of Motion Exercises. You can start mild activities after the fifth day of rest. Motion exercises include cycling.
- Grade 2. You suffer partial tears in the soft tissues. The injured region has intense and more diffuse tenderness. The area could be swollen and bruised. You are limited to performing light movements.
- Avoid sporting activity. You deserve around two weeks of rest if you suffer from a grade 2 turf toe.
- Modify footwear. Like with grade 1 injury, therapists recommend that you modify your footwear using Morton’s extension or turf toe late if you sustain a grade 2 turf toe.
- Immobilization. Your physical therapist could prescribe a walking boot to support the MTP joint.
- Progressive movement and exercises. You could perform light to mild exercises to protect the toe by taping or using a boot. You could then upgrade to activities like jumping, running, and pivoting.
- Grade 3. With this injury stage, your soft tissue complex is completely torn. The MTP joint could be dislocated. You experience severe swelling and pain in the big toe. It is hard to move the toe, leave alone in sporting activities.
- Immobilization. Severe turf toe injuries are treated with a few weeks of immobilization, like crutches or walking boots.
- Physical therapy. Your physical therapist could advise that you perform early movements to avoid stiffness. Physical therapy also helps you stretch and support the big toe.
- Rest. As an athlete, you are advised to avoid athletic activities for about eight weeks. During the eight weeks, you are to rest and recuperate. On average, symptoms could take about six months to cease.
Surgical Turf Toe Treatment
Turf toe injuries that need surgical treatment are rare. The physician would recommend surgery for:
- Acute grade 3 turf toe, including a major plantar complex tear or a sesamoid fracture, one of two small bones below the MTP joint.
- Continuation of symptoms like discomfort when performing push-off activities, and the effect on athletic performance.
After turf toe surgery, you could follow several guidelines while recuperating. These include:
- Doing minimal exercises to reduce stiffness a week after surgery.
- Wearing a toe spica splint for one month. The splint keeps the operated toe flexed downward and immobilized. Your physical therapist could advise that you avoid applying weight on the operated foot. After a month, you could apply weight when wearing a boot.
- At eight weeks, you could apply weight when using the recommended footwear, consisting of supportive shoes with taping and turf toe plate.
- Low, then medium-impact activities are added based on symptoms.
Turf toe treatment is easy when reported early. However, it could take six months to a year to completely heal. You want to wear inserts to avoid bending the big toe and playing on hard surfaces. There could be follow-up tests, x-rays, and scans. Also, your therapy could develop a plan for a gradual return to sporting activities once the pain reduces and there is flexibility, and muscle strength is restored.
Turf Toe Prevention
While it is possible to prevent the occurrence of turf toe, it is almost impossible if you sustained the injury in an accident. You could prevent turf toe by wearing shoes that offer enough stability for your activity. If you are a footballer, you want to avoid too flexible shoes in the big toe region.
Also, before partaking in a sport or an energy-intensive activity, spend a few minutes stretching and warming up. After your soft tissues and muscles are warm, the risk of sustaining an injury is lowered. You want to speak to your physician if you play sports like ballet, gymnastics, or football. They could help lower your chances of sustaining an injury.
Find A Las Vegas Physical Therapist Near Me
Turf toe is common in sporting activities and typical daily activities too. You sustain the big toe injury when you sprain the region by overextending the soft tissues where your toe is planted. Depending on your injury and the time you experience the symptoms, your physician could recommend non-surgical or surgical treatment. After treatment, you should avoid participating in sports until full recovery or, according to your therapist’s recommendation.
Schedule an appointment today with our orthopedic specialist at the Suarez Physical Therapy if you suffer from turf toe symptoms in Las Vegas, NV. Your health is important to us, and no referral is needed to consult us. Call us at 702-368-6778 to speak to a certified physical therapist and start your recovery path.