Metatarsophalangeal (MTP) joint sprain (turf toe) is a sprain of the great toe plantar ligament complex. Pain occurs with active and passive motion of the swollen joint. X-rays are needed to rule out fracture. Treatment is with buddy taping, analgesics, and usually physical therapy to help prevent chronic stiffness. Pain that persists more than a few weeks indicates a more severe sprain that may need surgical repair.
(See also Metatarsophalangeal Joint Pain.)
Etiology of Turf Toe
The plantar aspect of the great toe metatarsophalangeal (MTP) joint is stabilized by the joint capsule, plantar muscles and tendons, as well as the sesamoid complex.
The mechanism of turf toe is extreme dorsiflexion of the great toe MTP joint (more than 90°; eg, with the heel raised off the ground in pushing off to sprint). The injury is called turf toe because it was first described in football players playing on artificial turf, which—because it is a harder surface than grass—increases the distraction force with toe dorsiflexion during push-off and thus the risk of hyperextension and turf toe. However, turf toe can occur in any sport with sprinting or jumping that causes forced hyperextension of the great toe (eg, baseball, soccer, gymnastics). It can also occur chronically with repetitive hyperextension of the great toe (eg, in dancing). Some sports medicine physicians contend that athletic footwear that has flexible soles increases risk of turf toe.
Other than knee and ankle injuries, turf toe is the most common injury that causes university athletes to lose playing time.
Symptoms and Signs of Turf Toe
There is sudden pain in the great toe metatarsophalangeal (MTP) joint. Active and passive joint motion is painful, and the joint is swollen.
Diagnosis of Turf Toe
X-ray
Diagnosis is clinical, but x-rays should be obtained to rule out fracture. As with any sprain, the severity of a great toe MTP joint injury is graded I, II, or III.
Treatment of Turf Toe
Supportive measures (rest, buddy tape, ice, elevation, analgesics)
Physical therapy
Rarely, surgical repair
Patients should generally limit activity, apply ice, and buddy tape the great toe to the second toe to partially immobilize the affected metatarsophalangeal (MTP) joint. Over-the-counter nonsteroidal anti-inflammatory drugs may help reduce pain in the short term. Physical therapy aimed at increasing flexibility can help prevent chronic MTP joint stiffness. For grade II injury, limitation of joint motion during ambulation may help (eg, wearing a stiff-soled shoe, walking boot, or shoe with an orthotic insert). If symptoms, including limited joint motion, persist beyond several weeks (suggesting a grade III sprain), surgical repair by a foot and ankle specialist may be needed.
Prognosis for Turf Toe
In grade I injuries, symptoms usually resolve in a week or two. In grade II injuries, symptoms last > 2 weeks. In the rare grade III injuries (complete rupture of the plantar ligament complex), symptoms persist beyond several weeks and include continued difficulty moving the great toe.
Untreated turf toe injuries can result in chronic MTP joint stiffness.
Key Points
Turf toe is a sprain of the great toe metatarsophalangeal (MTP) joint and occurs with forced joint hyperextension.
The injury can occur in any sport that requires sudden jumping or cutting, especially on artificial turf.
Athletic footwear that is less supportive and flexible may increase risk of the injury.
Accurate diagnosis and appropriate treatment are imperative to help prevent chronic great toe joint stiffness and pain.
