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Turf toe

Turf toe is a sprain of the ligaments around the big toe joint. It’s caused by jamming the big toe or repeatedly pushing off the big toe forcefully, such as in running or jumping.

It is commonly seen in athletes involved in these sports:

  • Football
  • Rugby
  • Basketball
  • Running

Athletes who play on an artificial pitch are prone to turf toe. It is also a common injury for dancers.

Here’s more information about turf toe - what causes it, how to prevent it and how it's treated.

What causes turf toe?

Turf toe is a sprain affecting the ligaments around the joint of the big toe. These ligaments work mainly as a hinge to allow up and down motion. Just behind the big toe joint in the ball of your foot are two pea-shaped bones embedded in the tendon that moves your big toe. They are called sesamoids and work like a pulley for the tendon, levering the foot when you walk or run. They also absorb the weight that presses on the ball of the foot.

When you are walking or running, you start each step by raising your heel and letting your body weight come forward onto the ball of your foot. At a certain point you propel yourself forward by "pushing off" of your big toe and allowing your weight to shift to the other foot. If, for some reason, the toe stays flat on the ground and doesn't lift to push off, you run the risk of injuring the area around the joint. The same injury can happen during sport, if you are tackled or fall forward and the toe stays flat. The result is the same as if you bent your big toe back beyond its normal limit, causing hyperextension of the toe. That hyperextension, repeated over time or with enough sudden force, can cause a sprain in the ligaments that surround the joint.

Typically with turf toe, the injury is sudden. It’s most commonly seen in athletes playing on artificial surfaces, which are harder than grass surfaces. However, it can also happen on a grass surface, especially if the shoe being worn doesn't provide enough support for the foot. The injury often happens to athletes wearing flexible trainers or boots that let the foot bend too far forward.

What are the symptoms of turf toe?

The most common symptoms of turf toe include:

  • Swelling and bruising in the ball of the foot and the big toe
  • Inability to push off on the big toe
  • Limited joint movement in the big toe
  • Inability to bear weight on the ball of the injured foot

If turf toe is caused by repetitive injury, the symptoms usually develop slowly and gradually get worse over time. If it’s caused by a sudden forceful motion, the injury can be painful immediately and worsen within 24 hours. Sometimes when the injury occurs, a 'pop' can be felt. Usually the entire joint is involved and toe movement is limited.

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