What Is Turf Toe?

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Turf toe is a condition that affects the ligaments or other soft tissue under the big toe. This condition usually occurs when the toe is hyperextended (forced upward)—like when the ball of the foot is on the ground, and the heel is lifted.

This injury is common among athletes who play sports on artificial turf, which is how it got its name. However, it can also affect people who are not athletes.

This article discusses turf toe—symptoms, treatment, recovery time, and returning to activity after the injury is healed.

Turf sports field

kumacore / Getty Images

What Is Meant By a "Turf Toe" Injury?

"Turf toe" describes an injury to the metatarsophalangeal joint. This joint comprises ligaments that connect the bone on the sole of your foot, below the big toe (proximal phalanx), to the bones that connect your toes to the larger bones in your feet (metatarsals).

This injury is typically caused by hyperextension of the metatarsophalangeal joint, often resulting from a pushing off motion, like running or jumping. Turf toe typically occurs from athletic injuries, commonly in athletes who play on artificial turf. However, it can occur while playing on grass or other surfaces or during non-sports activities.

Turf Toe Grading

Turf toe injuries can range from mild to severe and are graded as follows:

  • Grade 1: The soft tissue is stretched, causing pain and swelling.
  • Grade 2: The soft tissue is partially torn. Pain is more significant, and there is more swelling and bruising. It is often difficult to move the toe.
  • Grade 3: Soft tissue is completely torn, and symptoms are severe.

Do I Have Turf Toe Symptoms?

Turf toe can be an overuse injury caused by repeating the same motion over an extended period, causing symptoms to worsen over time. Or, it can be an acute injury, meaning that it occurs suddenly, causing immediate pain. Symptoms of turf toe include the following:

  • Tenderness or pain in the big toe
  • Swelling
  • Bruising
  • Limited range-of-motion
  • Loose joints (indicating dislocation)

How It Is Diagnosed

If you're experiencing turf toe symptoms, see a healthcare provider for a proper diagnosis and treatment. A healthcare provider will ask about recent activities that may have caused or contributed to the injury. They will also do a physical exam to assess pain, swelling, and range of motion.

If your provider suspects tissue damage, they may recommend imaging with X-rays and magnetic resonance imaging (MRI) to grade the injury and determine the best course of action.

What Is Turf Toe Treatment?

A healthcare provider will determine turf toe treatment based on the severity of the injury. However, all turf toe injuries can benefit from the RICE protocol early on, which is:

  • Rest: Avoid activities that make the symptoms worse. This might include using an assistive device, such as crutches, to reduce pressure on the affected toe.
  • Ice: Apply ice for 20 minutes at a time, up to once an hour. Place a cloth between your skin and the ice pack to help prevent ice burn.
  • Compression: Wrap your toe and foot with an elastic bandage to support and reduce swelling.
  • Elevation: Prop your foot above the level of your heart to help decrease swelling.

Grade 1 Treatment

Grade 1 turf toe is characterized by stretched soft tissue, pain, and swelling. Treatments can include:

  • Taping to support the toe
  • Wearing shoes with a stiff sole
  • Orthotic support (such as a turf toe plate)

Grades 2 and 3 Treatment

Grades 2 and 3 turf toe injuries come with partial or complete soft tissue tearing and more severe pain and swelling. Treatments for more severe turf toe can include:

  • Limited weight bearing (including use of an assistive device, such as crutches)
  • Use of a walking boot or cast

Additional Treatment

Less than 2% of turf toe injuries require surgery. It is typically done if the joint is unstable or when conservative treatment is unsuccessful.

Physical therapy is also beneficial for decreasing pain and improving range of motion and strength after a turf toe injury. Physical therapy for turf toe also includes proprioception and agility training exercises and recommendations for orthotics and the best shoes for your specific physical activities.

A physical therapist can also help ensure that you do not return to your activities before your injury is fully healed—which can reduce your risk of reinjury.

Recovery Time From Turf Toe

Recovery from turf toe depends on the severity of your injury.

  • Grade 1: Subjective; varies depending on your pain tolerance
  • Grade 2: Four to six weeks of immobilization
  • Grade 3: Eight weeks (minimum) of immobilization

It can take up to six months to return to normal.

Resuming Normal Activity After Turf Toe

After a grade 1 turf toe injury, you can return to normal activities once your pain is under control. Grades 2 and 3 injuries take longer to heal. Your recovery timeline and return to activity depend on the severity of your injury.

  • Grade 1: Subjective; varies depending on your pain tolerance
  • Grade 2: Four to six weeks of immobilization
  • Grade 3: Eight weeks (minimum) of immobilization

Returning to sports activities after a grade 2 injury can take around two or three months, while grade 3 injuries—as well as turf toe that requires surgery—can take up to six months to return to normal.

Summary

Turf toe is an injury that affects the soft tissue—ligaments and tendons—at the base of the big toe on the underside of the foot. It is named after the most common cause of the injury—playing sports on artificial turf. These injuries vary in severity but typically improve with conservative treatment. In rare cases, surgery is required.

Recovery time after turf toe injury depends on the injury's severity and the type of activities you plan to return to. Pain is the primary barrier to activity after a grade 1 injury, while grades 2 and 3 take weeks to months to heal fully. Returning to high-level sports activities after more severe injuries can take six months.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Mass General Brigham. Turf toe.

  3. Foot Health Facts. RICE protocol.

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By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public.