Massage therapy · Kitchener–WaterlooFirst Metatarsophalangeal Joint Sprain

The MTP joint is held in place by a group of structures under and around it, called the plantar complex. These include a thick band of tissue under the joint (the plantar plate), the ligaments on each side of the toe, a tendon that helps the toe push off, and two small bones called the sesamoids. Turf toe can range from stretching of these tissues (grade 1), to a partial tear (grade 2), to a complete tear (grade 3) (American Academy of Orthopaedic Surgeons, n.d.).

How long it takes to recover depends on the grade. A grade 1 injury usually lets you return to sport as you can tolerate it, with little or no time lost (Najefi, Jeyaseelan and Welck, 2018). Most athletes with a grade 2 injury need 3 to 14 days of rest before returning to play (American Academy of Orthopaedic Surgeons, n.d.). A grade 3 injury may need 8 weeks or longer, and it can take up to six months for the symptoms to settle completely (Najefi, Jeyaseelan and Welck, 2018).

For milder injuries, taping the big toe can restrict its movement, and physical therapy with exercises to stretch and strengthen the big toe should begin as soon as your symptoms allow, because early movement is essential for reducing or preventing stiffness (American Academy of Orthopaedic Surgeons, n.d.). I can help with taping, hands-on work and a graded exercise programme. See the My Approach tab for how I work.

1. Rest

Take a break from the activity that caused the injury, and avoid walking or putting weight on the foot (American Academy of Orthopaedic Surgeons, n.d.).

2. Ice

Use a cold pack for 20 minutes at a time, several times a day. Avoid applying ice directly to the skin; wrap it in a towel instead (American Academy of Orthopaedic Surgeons, n.d.).

3. Anti-Inflammatory Medication

The American Academy of Orthopaedic Surgeons (n.d.) says over-the-counter anti-inflammatory medicines, such as ibuprofen and naproxen, can help relieve the symptoms of turf toe. (This medicine information comes from the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

4. Compression

To help prevent additional swelling, wear an elastic compression bandage (American Academy of Orthopaedic Surgeons, n.d.).

5. Elevation

To reduce swelling, recline when you rest and prop your leg up so it is higher than your heart (American Academy of Orthopaedic Surgeons, n.d.).

6. Footwear

A stiff-soled shoe or a shoe insert with a stiff front section can reduce stress on the joint (American Academy of Orthopaedic Surgeons, n.d.). I can help you work out what you need and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.

Options outside my scope

• Imaging: an X-ray can check for small bone fractures, and an MRI scan can show soft tissue damage in more severe injuries (American Academy of Orthopaedic Surgeons, n.d.).
• Walking boot or cast: more severe injuries may be treated with a walking boot or a cast for a period of time (American Academy of Orthopaedic Surgeons, n.d.).
• Surgery: surgery is often not needed, but may be recommended for severe grade 3 injuries, such as a complete tear, a broken sesamoid bone or an unstable joint (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

• Taping, and showing you how to tape it yourself
• Hands-on work and gentle mobilisation for the big toe and foot
• Exercises to restore movement, strength and push-off
• Footwear advice and a graded return to sport

If pain, swelling or stiffness isn't settling, or the joint feels unstable, see your family doctor or nurse practitioner.