If you’ve been hearing the term turf toe in sports news lately, that’s because it’s a fairly common injury in football and other field sports.
Turf toe develops most often in athletes who push off their toes while running, cutting, jumping, or even dancing or doing gymnastics. It can also affect recreational players, motorcycle drivers and generally active adults, too.
Despite the light-sounding name, turf toe can be a painful and even career-limiting injury if not treated properly.
What Is Turf Toe?
Turf toe is a sprain of the main joint at the base of the big toe.
This joint is responsible for stabilizing your foot as you push off while running or changing direction. When the big toe bends too far upward, the ligaments and soft tissues around the joint can stretch or tear.
The name “turf toe” comes from the higher incidence of this injury on artificial turf, where the surface doesn’t provide as much give as natural grass. The same type of injury can develop when playing on other surfaces, too, such as hard floors, in the case of dancers or other athletes.
How common is turf toe? One survey of 80 athletes in the National Football League (NFL) found that 45 percent had sustained turf toe injuries at some point in their careers. 83 percent reported that their injuries developed after playing on artificial turf.
Another study of elite college players found that about 11 percent had dealt with turf toe injuries.
What Causes Turf Toe?
This type of injury usually occurs when the front of the foot stays planted while the heel is lifted, which forces the big toe into hyperextension (when a joint is forced beyond its normal range of motion). This motion places too much stress on the big toe joint, leading to pain and injury.
Factors that can raise your risk for turf toe include:
- Playing on artificial turf surfaces, which are harder and less forgiving than grass
- Wearing flexible shoes, such as lightweight athletic shoes or ballet shoes, which may not provide enough support for the toes
- High-impact movements, such as sprinting, sudden stops, kicking or jumping
- Playing certain positions, such as running backs, wide receivers and quarterbacks, which are among the most impacted, likely due to frequent sprinting, cutting and toe-off movements
- Direct impact on the toes, such as being stepped on while playing
What Does Turf Toe Feel Like?
Turf toe symptoms can develop suddenly following a single injury or gradually from repetitive stress. Many athletes describe the injury as painful at the base of the big toe, which often worsens when pushing off the ground.
Other common signs and symptoms of turf toe include:
- Swelling and bruising around the toe joint
- Limited motion and stiffness in the toes and foot
- Tenderness when pressing on the toe joint
- Trouble walking normally or bearing weight on the foot (in severe cases)
Levels of Turf Toe: How Severe Is It?
Orthopedics classify turf toe into three grades based on the severity of symptoms. Knowing the grade helps determine the right treatment plan and how quickly an athlete can return to their sport.
- Grade 1 (Mild): The ligaments are stretched but not torn. Symptoms typically include mild swelling and soreness in the big toe, but athletes can usually keep playing with rest and taping.
- Grade 2 (Moderate): Partial tearing of the ligaments occurs. There is noticeable swelling, bruising and pain, and movement becomes more limited. Athletes often need to rest for several weeks.
- Grade 3 (Severe): Complete tearing of the ligaments and significant damage to the joint capsule. Symptoms include severe pain, major swelling and difficulty walking. This level often requires immobilization in a boot or even surgery, as well as significant time off from sports.
How Long Do Athletes Need to Avoid Sports to Recover?
While turf toe isn’t necessarily career-ending, it’s far from trivial and needs to be treated properly for people, and especially competitive athletes, to fully recover. Recovery from turf toe depends heavily on the severity of the injury and how it’s treated.
In a recent study of NFL players with high-grade turf toe, about 91 percent (48 of 53) eventually returned to play. Those treated without surgery all returned to play (28/28), and they did so in an average of 76 to 99 days.
Players who required surgery returned much later, on average, after about 221 days (or roughly 7 months). The study also found that some did not return to their previous performance level.
Treatment Options for Turf Toe
Most cases of turf toe—more than 95 percent—are treatable without surgery. However, each case is different, and ultimately, the right care depends on how severe the sprain is.
Treatment for and recovery from turf toe usually involves:
- Rest and modification, such as limiting activity that worsens pain for several weeks or more
- Ice and compression to help manage swelling
- Supportive shoes or taping, such as stiff-soled footwear coupled with taping to help limit motion in the foot
- Medications, such as over-the-counter anti-inflammatories to help reduce pain
- Physical therapy exercises to help restore flexibility and strengthen the foot
- In more severe cases where tissues are significantly torn, a walking boot or even surgery may be required
Prevention Strategies
The good news is that turf toe can often be prevented with a few smart steps:
- Wear properly fitted shoes designed for your sport that aren’t too lightweight
- Warm up and stretch before playing
- Avoid overuse; balance training and competitive days with rest days
- Use braces or taping if you’ve had turf toe before
When to See a Doctor
If toe pain keeps you from walking comfortably or bearing weight on your foot, head to your doctor for an evaluation. Untreated turf toe can lead to long-term joint problems in the foot and potentially chronic pain, so don’t ignore symptoms or wait too long to get help.
It’s a smart idea to visit a doctor if you experience:
- Swelling in your foot or toes that doesn’t improve within a few days
- Instability in your foot due to damaged joints
- Severe bruising or discoloration around the big toe joint
- Persistent stiffness or inability to bend the big toe upward
- Pain that worsens during activity and doesn’t improve with rest
- A “popping” sensation at the time of injury, followed by ongoing soreness
- Difficulty pushing off the ground while walking, running or climbing stairs
At Stony Brook Medicine’s Division of Sports Medicine, our orthopedic specialists treat athletes at every level, from students to professionals. Within our Foot and Ankle Surgery division, we provide advanced diagnostics, personalized treatment plans, and rehabilitation to help you return safely to the field, gym and other activities. Learn more about our locations and schedule a consultation here.
