Turf Toe Treatment

It is important to address turf toe injuries early. Early treatment facilitates healing and a reduction in symptoms. An ignored turf toe injury may result in a challenging repair and the likelihood of excessive swelling and extended inflexibility. Importantly, athletes may or may not be able to return to athletic competition in these situations.¹Coughlin, Michael J., Charles L. Saltzman, Robert B. Anderson. Mann’s Surgery of the Foot and Ankle. Philadelphia: Elsevier/Sanders, 2014. Print.

Ordinarily, joint stiffness and pain are the most frequent turf toe complications. Chronic symptoms range from bunions to decreased push-off strength.

Nonsurgical Treatment

While there are several nonsurgical options for people with turf toe, the grade of injury (grades 1, 2 and 3) influences the treatment.

Grade 1

• R.I.C.E. protocol. This four-part approach consists of: Rest, Ice, Compression and Elevation. For first 48 to 72 hours following the injury, it is recommended to ice the affected region two to three times each day for 20 minutes.¹Coughlin, Michael J., Charles L. Saltzman, Robert B. Anderson. Mann’s Surgery of the Foot and Ankle. Philadelphia: Elsevier/Sanders, 2014. Print.

  See The P.R.I.C.E. Protocol Principles

• Nonsteroidal anti-inflammatory medications. To reduce pain and swelling, anti-inflammatory medications may be taken.
• Toe protection. Orthotics provide support and reduce strain on the plantar complex. Athletes are advised to wear supportive shoes with a turf toe plate—a rigid carbon graphite insert—in order to restrict movement of the big toe. For the same reason, athletes can also wear individualized orthotics with a Morton’s extension: a rigid carbon graphite orthotic extending under the metatarsophalangeal joint (MTP), a big toe joint.
• Immobilization. There are differing opinions about taping the big toe to smaller toes. While this practice can reduce movement of the big toe, it can also limit circulation due to swelling after a severe injury. Using a walking boot to limit ankle motion for one to two weeks after the injury is an alternative for moderate immobilization.
• Range of motion exercises. Mild movements can begin after 3 to 5 days of rest. Exercises such as cycling are also permissible with proper toe support.

People with grade 1 turf toe are advised not to underestimate their injury. Rest is an important aspect of treatment, and athletic activity can worsen the sprain and its symptoms.

Grade 2

• Time off from sports activity. Normally, people with grade 2 turf toe need 3 to 14 days of rest.
• Adjust footwear. As with grade 1 turf toe, it is recommended to for people with grade 2 injuries to modify footwear by using a turf toe plate or Morton’s extension.
• Immobilization. A physician may also prescribe a walking boot to stabilize the MTP joint.
• Progressive movement and exercises. Light movements and mild exercises are permissible when protecting the toe by taping or using a boot. People can then proceed with activities like running, followed by push-off ones, such as jumping or pivoting.

Grade 3

• Immobilization. Acute turf toe injuries are ordinarily managed with a few weeks of immobilization: using a walking boot or crutches, at least initially.
• Physical therapy. Early movement is important to avert or limit stiffness; it is also advised to initiate physical therapy early to stretch and support the big toe.
• Rest. Athletes are advised to take about eight weeks off from athletic activity: resting and recuperating. It could take nearly six months for symptoms to cease.²McCormick JJ, Anderson RB. Turf Toe: Anatomy, Diagnosis, and Treatment. Sports Health. 2010;2(6):487-494. doi:10.1177/1941738110386681.

Even grade 3 turf toe can often be treated nonsurgically. A person may decide to have surgery if symptoms persist or athletic performance is compromised.

Surgical Treatment

Turf toe surgery is rare, since it is usually treated with nonsurgical methods.

Turf toe surgery is recommended for:

• Significant grade 3 injuries, including a major plantar complex tear or a sesamoid fracture, one of two small bones found below the MTP joint.
• Continuation of symptoms such as discomfort or difficulty with push-off activities, and the impact on athletic performance. Indeed, when nonsurgical treatments fail, surgery may be a viable option.

Post-operative management

There are several broad guidelines to keep in mind following turf toe surgery:

• Minimal exercises to reduce stiffness may start five to seven days after surgery.
• A person may be advised to wear a toe spica splint for four weeks: keeping the operated toe flexed downward and immobilized; it is recommended not to apply weight to the operated foot. At four weeks, weight can be applied while wearing a boot.
• At eight weeks, a person can apply weight when using proper footwear, consisting of supportive shoes with turf toe plate, and taping.
• Low, then medium-impact activities are added based on symptoms.

Turf toe injuries normally heal properly if managed early, but it could take six months to a year to fully recover to pre-injury level. It is recommended for anyone who has had turf toe to wear inserts to help avoid big toe bending and realize playing sports on hard surfaces long-term increases the likelihood of re-injuring the big toe.