In this week’s blog we are going to discuss sprains to the joint of the big toe (1st metatarsophalangeal or MTP joint), also known as ‘turf toe’
What is it?
Turf toe is an injury to the first MTP joint, the joint connecting the big toe and the foot. The joint is supported by the plantar complex (on the bottom) which is comprised of ligaments, flexor tendons,the joint capsule and the plantar plate, these structures function to provide stability to the joint.
Excessive stretch and strain to the joint can result in damage to the plantar complex, including the plantar capsule and 1st MTP ligament. The severity of the injury is dependent on the mechanism of injruy and can range from mild stretching of the tissues to partial or full tearing.
Mechanism of injury
Turf toe is most often caused by a traumatic incident and occurs when the toe is bent backwards into hyperextension. This can occur in activities involving:
· Pushing off during a run or stopping too quickly whilst your body weight is moving forwards and the foot is planted
· An external force (such as another player) falling onto the heel causing hyper extension of the big toe.
· Repetitive pushing off such as in running and jumping activities with flexible shoes.
This type of injury has been observed to occur in sports such as Soccer and American football and is common among Australian rules footballers, however it isn’t limited to these sports. Astroturf surfaces have also been linked to this injury due to the harder and less shock absorbent qualities compared to grass.
Signs and symptoms
The symptoms of turf toe can include:
· Localised pain over the 1st MTP joint
· Swelling and occasional redness around the 1st MTP joint
· Joint stiffness and limited range of movement
· Pain aggravated by weightbearing or movement of the big toe
· Occasional bruising and discolouration around the 1st MTP joint (more severe cases)
· Weakness of big toe flexion and pain with movement
How do we treat it?
In the very acute (early) stages:
Follow the RICE Regime à Rest, ice, compression and elevation to help manage pain and reduce swelling.
Taping to provide support and restrict ROM – taping techniques can include:
Buddy tapping to the adjacent toe or
Taping to the plantar aspect of the joint to restrict the toe moving into extension.
Wearing supportive/rigid shoes or using orthotics to provide some extra support and reduce stress on the plantar structures.
In very severe cases, immobilisation of the foot/toe may be required which involves a walking boot or cast.
Once the swelling and pain have reduced, rehabilitation can begin including:
Restoring normal range of motion
Restoring strength to the muscles around the toe and lower extremity.
In very severe cases with a highly unstable joint and failed conservative treatment, surgery may need to be considered.
Turf toe can be difficult to predict, but there are a few things you can do to minimise your risk especially if you engage it the sports mentioned above, these include:
Wearing more rigid (less flexible) shoes to provide more support to the 1st MTP and prevent excessive extension through the joint
Wearing an orthotic in your shoe will provide additional support to the arches of the foot and reduce the load through the 1st MTP
If you are prone to 1st MTP pain then wear preventative taping or bracing when engaging in activities or sports that aggravate it.
So that’s an overview of what Turf Toe is and how it occurs. If you have any questions or comments, please email us at firstname.lastname@example.org and we will be happy to answer them for you.
If you suffer with pain through the inside of your foot or big toe, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.