Tuft toe is a hyperextension injury of the great toe, causing a sprain to the metatarsophalangeal joint and damage to the joint capsule. Turf toe can be either an acute or a chronic condition. An acute turf toe often occurs when the athlete’s shoe sticks into the ground while he/she is trying to stop quickly. The shoe sticks as the individual’s body weight shifts forward, causing the big toe to jam into the shoe and ground. The chronic condition occurs from frequent running or jumping in shoes that allow excessive great toe motion. This mechanism of injury may occur on natural or synthetic surfaces. 19
Athletes with turf toe will present with pain at the 1st metatarsophalangeal joint. Swelling and stiffness may be present, however pain, especially with great toe extension is the primary symptom. Rehabilitation of turf toe typically requires several weeks. If left untreated, turf toe can lead to permanent decrease in range of motion and osteoarthritis arthritis. 19
Patients suffering from turf toe respond best with rest and an adjustment made to their shoes. Pain management should be of primary concern to the clinician. Once pain and swelling have been reduced, the athlete should start performing toe extension and flexion exercises such as toe crunches and short foot exercises. Joint mobilizations should be added to the treatment protocol to aid in pain and increase range of motion. Once pain and swelling is reduced, the athlete may begin to progress into athletic activities. Protecting the great toe with a stiff forefoot insert or a great toe taping may increase athlete comfort.
Criteria for full competition
Athletes are able to return to full competition when any pain and swelling has resolved. Often athletes with turf toe are capable to continue practicing and participating while suffering from this injury with the toe being taped and possible inserts into shoes.
Pearls of wisdom
Have patients wear stiff insoled shoes to prevent excessive motion
Great toe joint mobilizations can be incorporated to reduce pain and increase motion
Patients should be aware that if left untreated, turf toe may cause permanent decreased range of motion in the great toe and bone spurs may develop. Although athletes can often play with turf toe, rest and pain management is the most beneficial for athletes. Without prevention of excessive extension of the great toe, symptoms of turf toe may disappear with rest just to return once the athlete returns to activity.
Athletes with turf toe may benefit from adding a steel or other stiff material insert into the forefoot of the shoes to reduce extension. Taping of the great toe to prevent dorsiflexion may also be done.