Merck Manual

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Turf Toe

(Metatarsophalangeal Joint Sprain)


Paul L. Liebert

, MD, Tomah Memorial Hospital, Tomah, WI

Reviewed/Revised Nov 2023

Turf toe is a sprain of the ligaments on the underside of the big toe joint.

Turf toe is a common injury responsible for loss of playing time among athletes.

Causes of Turf Toe

Turf toe results when the joint of the big toe is bent upward more than 90° while the heel is raised off the ground (for example, when pushing off to sprint). Such a movement can sprain the ligaments and tear the soft tissues around the joint. Turf toe is more likely to affect athletes who play on artificial turf, which is harder and less shock absorbent than grass. However, any athlete at risk of jamming or hyperextending the big toe can develop turf toe, including gymnasts, wrestlers, and dancers.

Footwear with flexible soles may put an athlete at higher risk for this injury.

Did You Know...

  • Turf toe was named for its association with American football, which is often played on artificial turf. However, many sports put athletes at risk for jamming or hyperextending the big toe, including soccer, baseball, gymnastics, and dance.

Symptoms of Turf Toe

People with turf toe usually have sudden pain in the joint at the base of their big toe. The joint may become swollen.

As with any soft tissue sprain, the severity of turf toe can be mild, moderate, or severe. A mild sprain typically causes swelling and pain when the joint is moved and lasts for only a week or two. A moderate sprain causes pain and swelling in the big toe that lasts more than a couple of weeks. The most severe sprains involve complete rupture of ligaments on the sole of the foot. Severe sprains are rare, but the symptoms last for more than several weeks, and the person continues to have difficulty moving the big toe.

Diagnosis of Turf Toe

  • A doctor's evaluation

  • X-ray

Doctors make the diagnosis of turf toe by examining the person and noting where the pain and swelling are. They order x-rays to rule out a fracture.

Treatment of Turf Toe

  • Splinting ice, elevation, and analgesics

  • Physical therapy and new footwear

  • Rarely surgery

Doctors generally "buddy" tape the injured big toe to the second toe to partially immobilize the metatarsophalangeal joint (the joint connecting the metatarsal bone and the adjacent toe bone). Applying ice and elevating the toe for 24 to 48 hours after the injury can help limit pain and swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain over the short term.

For moderate sprains, wearing a stiff-soled shoe, walking boot, or a shoe with an orthotic insert is recommended to help to limit movement of the joint during walking. Physical therapy is also recommended to increase flexibility and help prevent chronic stiffness of the big toe.

If symptoms persist for several weeks or longer and limit motion of the big toe, the sprain is severe and may need to be repaired surgically. Doctors may refer the person to a foot and ankle specialist.

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