Turf Toe

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What is turf toe?

Turf toe is an injury to the underside of the big toe and joint at the base of the big toe. This joint, the first metatarsalphalangeal (MTP) joint, is commonly known as the "ball of the foot." Turf toe is specifically a sprain of the big toe joint. This injury may involve damage to ligaments, tendons, or bone separately or in combination.

This injury, often is a result of playing on artificial surfaces, was first documented in American football players in 1976. Turf toe was recognized as a common injury soon after the invention of AstroTurf in 1964. There are varying degrees of severity of the injury. While sometimes mild, which injured athletes can play through, turf toe is sometimes more serious and can be career-ending.

The amount of damage to the ligaments, tendons, bones, and surrounding tissues determines the severity of the injury. Though often referred to as a ligamentous injury or sprain of the MTP joint, the tendons may be strained and bones may be fractured. American football players such as Tom Brady and Deion Sanders and soccer great George Best are among the notable athletes to have suffered from this injury.

What is the anatomy of the big toe?

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The first MTP joint is a hinge joint with sliding and rotational components. There is also a set of paired sesamoid bones underneath the base of the big toe. There are nine ligaments that span the joint, which is covered by a capsular ligamentous balloon-like structure that helps holds the synovial fluid that lubricates the joint. The primary movers or muscles that move the joint of the MTP are the flexor hallicis brevis. Flexor hallicus longus are the muscles that plantar flex or curl the big toe; contraction of the extensor hallicus longus and brevis lift the toe and important muscles in normal foot function.

The primary movements of the joint at the base of the big toe are flexion and extension. The toe is also capable of being moved closer to and away from the foot.

What causes turf toe?

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Turf toe commonly occurs as an athlete tries to push off of the ground, causing a stretch or hyperextension injury to the structures on the bottom of the big toe.

In a 1993 survey of 80 National Football League players, 36 players reported that they had incurred a turf toe injury and 83% of those players reported that the injury had occurred on artificial turf. Older players and those with more experience in professional football were more likely to have sustained a turf toe injury.

Turf toe injury does cause a lasting decrease in first MTP motion and increased plantar foot contact pressures in football players.

Turf toe, foot, and/or toe pain (metatarsalgia) may also be caused by arthritis, contusions, blisters, bunions, neuromas, sesamoiditis, hammertoes, fractures, and gout.

Medically Reviewed by a Doctor on 2/10/2015

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Treatment of Foot Pain

Treatments are optimally directed toward the specific cause of the pain.

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain.