Massage therapy · Kitchener–WaterlooTurf Toe

It is common in American football, and it became especially common after artificial turf became widespread, which is how it got its name. Artificial surfaces are harder and less shock-absorbing than grass, and the flexible shoes designed for them give less support to the front of the foot (AAOS, n.d.a). It also occurs in a wide range of other sports and activities.

Turf toe injuries are graded from 1 to 3, mild to severe (AAOS, n.d.a)

• Grade 1: the tissues under the joint are stretched, causing pinpoint tenderness and slight swelling.
• Grade 2: the tissues are partly torn, causing more widespread tenderness, moderate swelling and bruising. Moving the toe is limited and painful.
• Grade 3: the tissues are completely torn, causing severe tenderness, swelling and bruising. It is difficult and painful to move the big toe.

A doctor may also arrange an X-ray to check for small fractures or problems with the small sesamoid bones, or an MRI scan to look at the soft tissues in more severe injuries (AAOS, n.d.a).

• Plantar plate: a thick, fibrous tissue under the joint that stops the big toe bending too far upwards.
• Collateral ligaments: ligaments on each side of the big toe that stop it moving too far from side to side.
• Flexor hallucis brevis: a muscle whose tendon runs under the first metatarsal and gives strength and stability to the big toe when pushing off.
• Sesamoids: two small bones within the tendon that help it move smoothly and help bear the weight placed on the front of the foot.

Turf toe is an injury to any of the soft tissues of the plantar complex, ranging from stretching to partial tearing and, in the most severe cases, dislocation of the joint (AAOS, n.d.a).

For milder injuries, taping the big toe to the smaller toes can limit its movement, and physical therapy with stretching, strengthening and early joint movement, started as soon as symptoms allow, helps reduce or prevent stiffness (AAOS, n.d.a). I can tape your toe and guide you through this, after a doctor has checked it first if your injury is severe. 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 at first (AAOS, n.d.a).

2. Ice, Compression and Elevation

Use cold packs for 20 minutes at a time, several times a day, and never put ice directly on the skin. An elastic compression bandage can help prevent more swelling, and propping your foot up higher than your heart when resting helps to reduce swelling (AAOS, n.d.a).

3. Stiff-Soled Shoes and Inserts

A stiff-soled shoe, or a thin graphite shoe insert with a rigid front section, can reduce the stress on the plantar plate and give the toe more stability (AAOS, n.d.a). With a mild (grade 1) injury, pain is usually manageable and athletes can often carry on with sport in a stiff-soled shoe (AAOS, n.d.a).

Options outside my scope

• Walking boot or cast: a doctor may use a walking boot or cast to keep the big toe joint still for more severe (grade 2 or 3) injuries (AAOS, n.d.a).
• Surgery: an operation to repair the damaged soft tissues; it is often not needed, but may be an option for severe grade 3 injuries (such as a severe tear, a broken sesamoid bone, an unstable joint or a loose bone chip) or if symptoms persist (AAOS, n.d.a).

How I can help (see the My Approach tab)

If your toe becomes more painful or swollen, or you can't put weight on your foot, see your doctor.