Commentary

What turf toe is -- and how to treat it

The term "turf toe" originally was used to describe injuries of the big toe joint sustained by American football players on artificial turf in the 1970s. The firmness of artificial turf caused the big toe joint to bend upward beyond it’s normal range. This often occurred when a player was tackled from behind or stepped on another player forcing the toe upward.

Soccer players, especially those who frequently play on artificial turf or indoor soccer, are susceptible to turf toe.

Turf toe can occur in sports not played on turf such as tennis and in gymnastics. In some cases the toe joint is sprained (ligaments stretched), but in other cases the big toe is moved so far beyond its normal range it would come out of its socket and dislocate. Oftentimes this injury resulted in cartilage injury (joint damage) and could also create a fracture of the bones under the big toe joint known as sesamoid bones.

Athletes who had severe or multiple injuries tended to develop arthritis, which is basically loss of the joint space between the bones that make up the big toe joint. Over time, these athletes would develop bone spurs, which is the body’s way of protecting the joint from painful motion. This results in loss of big toe motion and is called “hallux limitus” in milder cases and “hallux rigidus” in more severe cases. In some cases, the ensuing bone spurs could break off from continued activity and injury, further damaging the joint.

It soon became clear that due to the many structures of the big toe joint, “turf toe” could be a few different types of injuries -- not just one specific condition or anatomical structure. The primary method of prevention is use of stiffer shoes/cleats and taping (particularly for sports where one is barefoot).

Treatment of turf toe depends on the severity of the injury and the specific area injured. The doctor must assess the damaged area and joint stability is critical.

Young athletes should be carefully examined because their bones are softer, and growth plates can be broken or damaged, resulting in fractures. These individuals are at risk for premature arthritis. X-rays are typically ordered. An MRI or CAT scan may be helpful as well. Most turf toe injuries can be treated without surgery. Mild sprains usually need some relative rest, ice and stiffer shoes and/or insoles.


Often times a specific foot insert (orthosis) or turf toe insole is used to help an athlete return to play. These keep the big toe from bending too much.

Sometimes a cleat is directly under a sesamoid; removing the sesamoid can be helpful. Moderate cases usually need a boot as well as non-weightbearing.

Dislocations that involve joint damage, complete dislocation or sesamoid fractures can be season-ending and may require surgery. Patients who have turf toe injuries should keep track of their symptoms and loss of motion in the long-term, beyond their competitive career to make sure they are not developing significant arthritis. Sometimes surgery is needed and certain procedures for this arthritic condition of the big toe as a result of turf toe do allow patients to return to sports in most cases.

(Amol Saxena is a Podiatrist specializing in specializing in Sports Medicine/Foot and Ankle Surgery at the Palo Alto Medical Foundation in California and a Consulting Physician for USA Track and Field. Saxena is also a Clinical Advisor to SidelineSportsDoc.com, whose online injury-management course is a requirement for US Club Soccer coaches and staff members. This article first appeared in the SidelineSportsDoc.com injury recognition and management blog.

3 comments about "What turf toe is -- and how to treat it".
  1. frank schoon, March 3, 2018 at 10:47 a.m.

    This garbage should be outlawed for playing official games on and used possibly for practice only.
    In Holland they are seriously considering banning it for proplay, the only quest is now to find a way to compensate some of the smaller proclubs in reverting back to grass..

  2. frank schoon, March 3, 2018 at 10:56 a.m.

    Passing, shooting, dribbling, trapping, tackling is different when it is done on turf and it certainly, likewise,  doesn't help in teaching these aspects to kids. It is obvious a benefit for those who lack skills for it is a "SKILL REDUCER" to the better players and gives the lesser player more of a chance. 
    Teams like Ajax with players who have good skills tend have to have difficult time playing against a club with turf....TURF DOES NOT COMPLIMENT THE GAME OF SOCCER. 

  3. Ray Lindenberg , March 7, 2018 at 10:25 a.m.

    Good reminder and tips on turf toe injury health and safety in this article. What was overlooked is a greater emphasis on prevention. Yes, you can prevent, to a great degree, or at least minimize, the severity of a painful event of turf toe event, which can happen on any surface, not only artificial turf.


    Coaches must take greater care and place a higher priority on the proper warm-up of players prior to putting them through practice or allowing them to play ... and this includes every sport (not only soccer) and every age group -- even toddlers. The body and muscle groups simply need to 'wake up' and get more oxygen pumping to them through the blood prior to playing and physical activity so that the muscles are more responsive and supple, to prevent and minimize injury and to pave the way for a quicker recovery if the body identifies that it has been injured.


    And as a bonus -- players who take care of and respect their bodies by stretching and warming-up properly tend to have an inside track on playing better. Toddlers too, who are admittedly more flexible, should be taught to appreciate proper athletic warm-up and learn the paces paces from the second they start playing any sport, even as 3 year-olds. Teach them the right and professional way from the get-go.


    At least 10-minutes of stretching and warming up all muscle groups should ensue before touching a soccer ball.  The  warm-up should especially zero in on the knees and feet (ankles and toes), which only take a minute or two of stretching drills to make a world of difference when it comes to injury prevention. Gotta especially protect them knees and feet, which are especially high injury risks in soccer, and could cause severe career playing and long-term painful arthritis consequences if not protected properly as young athletes.

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