Ankle and Foot
Turf toe is the term used in sports medicine circles to describe a jamming or impaction injury of the great toe joint (1st metatarsophalangeal joint). Another, more appropriate name for this condition is hallux limitus.
Historically, the term “turf toe” developed due to an increased incidence of 1st MPJ soft tissue injuries in football players wearing flexible cleats allowing hyperextension at the 1st MPJ and jamming of the joint while playing on artificial turf.
Turf toe injuries account for more missed practice and training than ankle sprains, despite occurring less often
Turf toe can be both acutely and chronically disabling if not treated appropriately. In fact, approximately 50% of all patients with hallux limitus (turf toe) have persistent symptoms which include hallux rigidus (severe degenerative joint disease with loss of range of motion of the 1st MPJ), hallux valgus (bunion deformity), chronic capsulitis and/or extensor tendinitis.
Turf toe caused by a direct injury to the joint may or may not obvious initially. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the training progresses.
Turf toe pain will subside with rest only to recur with increased activity
It’s not unusual to see symptoms of turf toe resolve in the off-season only to recur with renewed exercise. This condition is not just associated with sports or training injuries to the 1st MPJ. Some sedentary patients have a biomechanical abnormality which results in jamming of the 1st MPJ with every step. After several years, degenerative changes occur causing a hallux limitus or rigidus.
Many factors have been implicated in the increased incidence of turf toe
These reasons include:
It's important to understand that the terms turf toe and hallux limitus are similar but aren’t synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles that refers to an injury of the great toe joint. On the other hand, hallux limitus, refers to a broader, ‘non-athletic’ patient population and need to include all the above listed causes of hallux limitus.
Turf toe is graded in severity ranging from grade 1 through grade 4 depending on the severity of the condition.
Biomechanics of Turf Toe
Normal function of the great toe joint (1st metatarsal phalangeal joint) requires that the 1st metatarsal bone plantarflex (move down) to allow the proximal phalanx to ride up (dorsiflex). This hinge action needs to take place with each step. If the normal range of motion is limited in any way, jamming of the joint will occur and hallux limitus will ensue. There are two known biomechanical factors that contribute to the formation of hallux limitus.
Those factors include:
Symptoms of Turf Toe
Symptoms include pain with the onset of activity. Swelling and stiffness of the great toe joint increases with activity. Bruising may occur following the initial injury but is not commonly seen as turf toe progresses.
There may be radiating pain if that extends from the 1st MPJ dorsally (top of foot) towards the ankle. This is usually due to a chronic extensor tendinitis/capsulitis. Transfer of the weight to the lateral side of the foot to aid in propulsion and limit 1st MPJ dorsiflexion. Chronic pain to the outside and ball of the foot may ensue as a result of this compensation.
Most turf toe injuries are treated non-surgically. If surgery is performed for this condition it is usually after years of repetitive jamming and destruction of the joint requiring joint replacement surgery. Prevention by addressing the biomechanical influences for turf toe is the key to treating this condition pallitively.
An initial assessment to rule out fractures or dislocations is made. Once ruled out, treatment is geared at protecting the soft tissues and allowing for functional rehabilitation.