Turf toe or first metatarsal-phalangeal (MTP) joint sprain is an injury to the joint capsule and ligaments that connect the big toe to the rest of the foot, causing pain at the ball of the foot. The joint consists of nine ligaments, four bones and three muscular attachments.
The severity of the injury depends upon the degree of damage that occurs to the ligaments and joint capsule. Injury can range from a mild stretch to a complete tear. It occurs when the big toe gets bent too far upward (hyperextension) or downward (hyperflexion). This can occur with jamming the big toe, pushing off a hard surface, or pushing off repeatedly from the ball of the foot when running or jumping.
Symptoms of turf toe include:
- Pain at the base of the first toe that is worse with running and jumping.
- Swelling and stiffness.
- Bruising and limitation of motion in more severe injuries.
Turf toe is diagnosed based on your mechanism of injury and physical examination of your foot. X-rays are important to look for fractures, but an MRI may be necessary to evaluate the soft tissue (ligament and capsule) injury at that joint.
Treatment begins with rest, elevation, ice, and anti-inflammatory medication. A stiff-soled shoe, walking boot or cast may be used to limit motion at that joint and allow healing. Physical therapy can be used after the initial treatment to restore motion and strength. Surgery may be recommended for turf toe if symptoms do not improve after several months of rest and physical therapy, if joint range of motion is severely limited, or if there are associated injuries such as a fracture. Return to sports can be done as early as two to three weeks in low-grade injuries, but may take more than three months for high-grade injuries. A stiff-sole shoe insert or shank may be necessary to allow for a return to sports.