Turf Toe

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

What Is Turf Toe?

So what is Turf Toe? It is essentially a sprain of the soft tissues surrounding the big toe, known as a metatarsophalangeal joint sprain. There are three grades when classifying the toe sprain:

What Causes Turf Toe?

A turf toe injury develops when the big toe is bent too far back into hyperextension, most commonly when front of the foot is fixed to the ground, the heel is lifted and a force pushes through the toe.

Metatarsophalangeal Joint Sprain Symptoms

The symptoms of Turf Toe vary depending on the severity of the injury:

Grade 1: Mild, localized pain with minimal swelling around the big toe

Grade 2: Moderate pain, swelling and bruising at the big toe and surrounding area

Grade 3: Severe pain, swelling and bruising around the joint and difficulty moving the big toe and walking

Pain can usually be felt immediately at the time of injury but may get worse over time as the swelling increases. With all grades there is usually some big toe pain when walking.

Risk Factors

How Is It Diagnosed?

Your doctor can usually diagnose a metatarsophalangeal joint sprain from what you tell them about how the injury occurred, the sports you play and your footwear.  They will examine your feet and may order an x-ray to check for signs of any damage to the bone, from either a fracture or arthritis.

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Turf Toe Treatment

The aim of Turf Toe treatment is to reduce pain and inflammation, and protect the joint from further damage. Treatment will depend on the severity of the injury. As a guide:

• Grade 1 Injuries: usually settle within a few days and are best treated with a combination of PRICE and strapping
• Grade 2 Injuries: may require the use of a walking boot to immobilize the joint for around one week, and then strapping. They usually take a couple of weeks to settle
• Grade 3 Injuries: may require several weeks of immobilization with either a walking boot or a cast that holds the toe in slight flexion, followed by strapping or a turf toe brace and physical therapy to regain full range of movement

Common turf toe treatment involves a combination of:

1. PRICE

• Protect: To protect the big toe joint from further damage you should stop playing sport immediately and limit exercise. It is fine to keep walking with a metatarsophalangeal joint sprain, although you may need crutches if it is really sore
  
  
• Rest: The joint will need time to recover so you will need to rest from sports for a few weeks.  You should avoid activities where you push through your toe such as running, and you may need to use crutches initially so you aren’t putting any weight through your foot at all when walking. In severe cases, you may be given a cast or special walking boot that stops the toe from moving altogether
  
  
• Ice: Regularly applying an ice pack for 10-20 minutes every 2 hours helps to reduce any inflammation.  Find out how to safely and effectively use ice in the Cold Therapy section
  
  
• Compression: You can help reduce further swelling by wearing a compression bandage like tubigrip
  
  
• Elevation: keeping the foot raised higher than the level of your heart will help to reduce swelling e.g. with a leg cushion

2. Strapping

As part of Turf Toe treatment it can really help to strap or tape the big toe to the second toe. This helps to limit movement and reduce the stress on the big toe

3. Anti-Inflammatory Medication

Your doctor may advise a non-steroidal anti-inflammatory (NSAID) such as ibuprofen or naproxen to help treat the toe pain and inflammation with a metatarsophalangeal joint sprain. It is generally much better to take painkillers and be able to move around normally than to try and make do without them.

4. Physical Therapy

Mobilizations and exercises to stretch and strengthen the big toe will help prevent any long-term stiffness developing with a Turf Toe injury. This is particularly important with grade 3 injuries as the last thing you want is ongoing problems.

5. Surgery

In severe cases of metatarsophalangeal joint sprain, surgery may be required. This is usually if there is ongoing pain and instability or a bone spur has formed which limits toe movement.

How To Avoid Toe Sprains

Turf Toe Recovery

Full turf toe recovery usually takes three to four weeks, during which time complete rest from sport is required.  It is really important to rest properly and not to return to sport too soon.  If you keep aggravating the joint, the ligaments/capsule will not heal properly and recovery will take much longer. 

Athletes who do not rest properly or address the cause of their metatarsophalangeal joint sprain are likely to develop long term problems such as arthritis and stiffness in their toe, known as hallux limitus.

What Else Can Help?

There are a number of other causes of toe pain such as hallux rigidus (stiff big toe) and bunions.  If turf toe isn't sounding quite like your problem, visit the toe pain section.  Alternatively, if you want help working out what is causing your pain, visit the foot pain diagnosis section. 

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Page Last Updated: 19th November, 2024
Next Review Due: 19th November, 2026