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Turf Toe: The Underestimated Injury

An injury named after a playing surface? How bad can it really be? It doesn’t have the intimidating ring of “bone spur” or “calcaneus fracture.” While turf toe may sound simple and less-than-threatening, it is often dangerously underestimated and can be career threatening for some athletes. Many players and coaches don’t respect this injury since ‘my toe hurts’ sounds like a pretty weak excuse to sit out of game or practice in order to recover. However, it has been known to be a disabling injury for some athletes, since the big toe is critical in any type of sport that requires the athlete to push off from the surface, such as running, cutting, or jumping.

A turf toe injury is essentially a sprain of the first joint of the toe (where the toe meets the foot), usually because of hyper-extension (over-extension) of the big toe. This injury was inconsequential prior to the use of artificial turf for playing fields, since the sprain is caused by a flexible shoe on a harder surface. Before the use of turf, real grass was used, providing a softer and more forgiving playing surface. Football players, especially running backs, lineman, and receivers, are the athletes most likely to injure their toes this way because of the prominence of artificial turf on football fields.

This injury is easily missed in athletes because a fracture isn’t present. Turf toe injuries usually result in straining of the ligament in the joint, damage to soft tissue, and bruising of the bone.

Symptoms of a turf toe injury include swelling, pain under the joint and limited range of motion. Depending on the severity of the sprain, treatment options can range from shoe wear modification and icing to toe casts and crutches, and recovery time can range from three days to six weeks. Happily, surgery is only needed in the most severe cases. No matter the grade of the injury, it should not be ignored and should be treated by an orthopedic foot specialist.

In order to prevent turf toe injuries, ensure that shoes (football cleats especially) are rigid enough to provide stability and protection for the toes. If possible, train and condition on softer sod instead of artificial turf. If these guidelines are followed, hopefully big toes around the country can serve a happy, sprain-free career.

– David A. Porter M.D. PhD