Houston Methodist. Leading Medicine

Foot FAQ

Question:

The outstanding football receiver for our university football team is out with a turf toe injury. This year we have a chance to win our division championship but it might not happen without him. How long does it take to recover from an injury like this?

Answer:

Turf toe describes damage to the base of the big toe. The medical term for this problem is hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Hyperextension means the toe is bent way back on itself. It's called turf toe because most of these injuries occur on artificial turf. The injury can be mild (grade I) to severe (grade III). Treatment and length of time on the bench depend on the severity of the injury. With a grade I injury, the ligaments around the base of the big toe are stretched and strained but nothing is torn or broken. The player may experience some pain, perhaps a little bruising, and some swelling. He may not even miss a game or practice because of it. Grade II injuries are a little more problematic. Some of the soft tissue structures are torn. Swelling and pain limit motion. A walking boot and crutches may be needed. The player will be off the field for up to two weeks. When he does return, the athletic trainer will likely tape the toe to protect it for another two weeks. In the most severe injuries (grade III), there is significant swelling, bruising, and pain. That's because the ligaments, joint capsule, and cartilage under the toe have been completely torn or ruptured. As a result, the hallux metatarsophalangeal (big toe) joint is weak and unstable. At all levels of severity, treatment begins with managing the symptoms using the tried and true formula of R.I.C.E. -- rest, ice, compression, and elevation. Anti-inflammatory medications help keep the swelling down. Accurate diagnosis with physical exam and imaging studies (X-rays, MRIs) help determine whether the athlete will continue with conservative (nonoperative) care or go on to have surgery. With low-grade injuries, a splint, cast, or boot is used to immobilize the foot and protect the soft tissues while healing takes place. Some cases can be treated with long-term (six to eight weeks or longer) immobilization in a boot or cast. But surgery is often required for grade III turf toe injuries. The surgeon makes every effort to restore the toe to its normal anatomy. Most of the time, the soft tissues can be repaired and stitched back in place. The player with this level of injury will be off the field for three to four months. The timing of his return-to-play may depend on the position he plays on the team. At a minimum, before being released to full participation (especially running or explosive movements), athletes with turf toe must have 50 to 60-degrees of passive toe flexion without pain. Passive motion means the examiner moves the patient's toe rather than the player actively bending the toe himself. But sports fans can relax because orthopedic surgeons have the problem well in hand. Early diagnosis and treatment will ensure that affected athletes will be back in action as quickly as possible. If you find out what "grade" his injury was listed at, you'll have a better idea of how long he will be off that foot. Jeremy J. McCormick, MD, and Robert B. Anderson. Turf Toe: Anatomy, Diagnosis, and Treatment. In Sports Health. November/December 2010. Vol. 2. No. 6. Pp. 487-494.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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