Turf Toe: Symptoms, Causes, and Treatments (cont.)
Jayson Goo, ATC, MA, CKTI
Jayson Goo, ATC, MA, CKTI, a National Athletic Board Certified Athletic Trainer, graduated from the University of Hawaii and earned his master's degree in human performance with a specialty in corrective therapy from San Jose State University. Jayson also is an active Certified Kinesio Taping Instructor.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is turf toe?
- What is the anatomy of the big toe?
- What causes turf toe?
- What are turf toe symptoms and signs?
- When should I seek medical treatment for turf toe?
- How is turf toe diagnosed?
- What is the treatment for turf toe?
- What follow-up care is needed after foot pain is treated?
- Is it possible to prevent turf toe?
- What is the prognosis for turf toe?
- Find a local Doctor in your town
How is turf toe diagnosed?
Turf toe is diagnosed clinically from the history and physical examination. Athletes who suffer from turf toe will often describe it as having their foot or their toe getting "stuck" on the ground at the same time they move forward. The American Association of Orthopedic Surgeons says that the common mechanism of injury is to have the big toe or forefoot stuck on the ground as the heel raises and the foot is extended or plantar flexed. X-ray and/or MRI testing is sometimes used to support the diagnosis and rule out fracture. The doctor will ask several questions to determine how the problem began. It can be helpful for the patient to tell the physician about how and when it occurred, how it affects him/her, when it bothers him/her, and what he or she may (or may not) have done to make the pain better or worse. The medical practitioner will examine how the patient's MTP joint functions. These tests may involve holding or moving the toe against resistance. The patient may also be asked to stand, walk, or even run. The nerves in the foot will be tested for injury. Knowledge of the location, intensity, and aggravating or relieving conditions helps the physician and therapist to determine the cause of the pain and stage of injury.
What is the treatment for turf toe?
Acute management of turf toe injuries includes rest, ice, compression, and elevation (RICE). Immobilization will allow the affected tissues to begin to heal without stressing the joint. Ice will help to manage the discomfort and reduce swelling, while compression will aid in stopping bleeding under the skin surface and prevent fluid accumulation in the joint and surrounding areas. Elevation will drain and prevent fluid from accumulating in the joint. Over-the-counter (OTC) medications can help to manage pain and inflammation from the injury. A physician may prescribe stronger medications for inflammation. Once the severity and cause of foot pain is determined, a course of corrective and rehabilitative actions can be started. Goals of treatment include pain management, increasing muscle strength and range of motion, maintaining cardiovascular conditioning, and re-establishing neuromuscular control. The following treatments and exercises are instituted at the appropriate phases of recovery.
- Qualified medical personnel may use electrical medical devices such as ultrasound, various forms of electrical stimulation, LED light therapy (laser), and/or manual therapies to reduce pain and increase circulation to the area to promote healing.
- Various stretching and strengthening exercises and techniques are gradually added.
- Rehabilitation will likely include exercises to maintain and improve the range of motion (ROM) of the joint; strengthening exercises of the small muscles of the foot along with the calf, lower leg, and core muscles should be addressed; and cardiovascular conditioning often including stationary biking.
- Maintenance of fitness levels via modification of activity
- Substitute for activities that aggravate the pain and soreness. Running causes the body to have repetitive impact with the ground. The use of bicycling, elliptical trainers, step machines, swimming, or ski machines minimize impact and allow the individual to maintain and improve his or her fitness without causing irritation to the injury.
- Biomechanical evaluation
- The body will create various changes in the natural movement after an injury. A therapist can evaluate these biomechanical changes and help make the appropriate corrections. Prolonged, uncorrected biomechanical changes may lead to secondary mechanical changes that are painful and difficult to correct and may lead to a poor prognosis and possibly a slow or incomplete recovery from the symptoms.
Footwear often does not provide enough support for the person with turf toe. Corrective and OTC orthotics may also be of use. In-shoe supports (such as a steel insole), prophylactic athletic strapping or bracing, and a decreased range of motion may be needed. Occasionally, surgery may be necessary to repair or remove scar tissue or loose bodies that are in the joint.
What follow-up care is needed after foot pain is treated?
There may be follow-up tests, scans, or X-rays. A plan for a gradual return to play begins once the pain is reduced and muscle strength and flexibility are restored.
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