Turf toe is a common painful condition affecting the ligaments surrounding the big toes in the feet, with symptoms similar to aching heels experienced in plantar fasciitis. Ligaments are firm supple tissues covering the joints, which link one bone to another, thereby supporting the structural integrity of the joints and restricting their range of motion to a normal extent. Turf toe, also known as a hyperextension injury of the metatarsophalangeal (MTP) joint, is a frequently occurring incident in sportsmen, foremost among them being football professionals and soccer pros, who regularly engage in vigorous physical activity on synthetically set lawns. However, in seldom instances, turf toe also develops in normal individuals who use their feet constantly while doing work or walk for long distances continuously.
In fact, turf toe was designated as such, due to the arena used in conducting matches in American football being artificial turf rather than genuine grass, where the former is a much harder surface lacking cushioning soil below. Thus, applying massive pressure as well as balancing entire body weight on the big toe while preparing to run or jump in such firm fields makes sportsmen prone to acquiring a turf toe. Also, the terrain of turfs in stadiums is very slippery in rainy weather and icy conditions, when compared to original grass surfaces, thereby making the players prone to injuring their toes by accidentally skidding or jamming their feet down hard on the area. Besides American football and soccer players, basketball stars, competitive wrestlers and ace ballet dancers also experience instances of turf toe quite often.
Causes Of Turf Toe
Turf toe occurs when the big toes in either one or both feet are twisted to a much greater extent in a backward direction facing the foot than their normal range of motion. This invariably hurts the plantar complex, comprising the MTP joint and the region around the big toe. Activities such as playing intense sports like football, basketball that involves running, jumping frequently, donning high heels, walking for prolonged periods putting undue strain on the feet often result in injury to the MTP joint and the big toe. Moreover, performing arduous tasks that utilise the feet a lot and wearing uncomfortable footwear while jogging, going for a walk or run, playing sports give rise to cases of tur toe as well.
Specifically four points in the feet get affected prominently and result in pain and swelling. These include the sesamoids, which are two tiny bones in the feet which help the anterior portion of the foot support the weight of the body and the flexor hallucis brevis, a tendon that balances the big toe when massive weight or force are applied to it while jumping, sprinting, walking at a very fast pace. The collateral ligaments, which are tissue cords joining the toe bones, preventing excessive flexing of big toes in both forward and backward directions and the plantar plate, a solid assembly that averts too much curving of big toes, are impaired as well.
The characteristic indications of turf toe are usually very slight in the beginning, but if left unattended to and upon continued twisting of the big toe can worsen due to repeated stress on the ligaments and MTP joint. The defining signs of turf toe consist of:
- Considerable pain and aching in the big toe, that becomes more intense when bending it or applying much weight, pressure on the feet, like the pain endured in the leg, calf muscles in Achilles tendinitis
- A distinguishing “pop” sound that occurs while flexing the big toes
- Inflammation in the vicinity of the big toe, feet and heels, with rigidity and lack of normal movements, such as in calcaneal spur/heel spur
- Soreness and reddening of the area surrounding the big toe
- Joint pain and aching in feet, heels, while running, walking, jogging and playing sports
The doctor performs a full physical examination to analyse signs of overall bone and joint health and also enquires about any recent injuries due to exerting the body at work or while playing sports. The range of motion of the big toes is tested by pushing it in all directions, which also helps to identify the point of origin of pain in the feet.
After externally studying the area around the big toes for any signs of tenderness, swelling, the physician also carries out imaging analyses of X-rays and MRI scans. These visual depictions of the internal tissues assist in spotting any irregularities in the structure of the bones and joints in the big toes, heels and feet.
Depending upon the severity of injury to the big toes and the intensity of pain experienced, the appropriate treatment measures are given for turf toe. In minor situations, RICE or rest, ice, compression, elevation is recommended by the healthcare professional, entailing relaxing the body, applying ice packs in the toes, feet, wearing tight bandages to prevent excessive motion of the toes and lying flat with feet raised above to reduce swelling.
However, when turf toe injuries are more serious, with prominent damage to bones in the feet, then crutches and walking boots have to be used until the wound in the toes mends completely. Severe impairment of the big toes requires surgery to rectify the defects in the joints and ensure complete healing of turf toes in the patient.