By: Kaitlyn Keyser, PT, DPT, SCS, ATC, CSCS

What is turf toe?

The textbook definition of turf toe is an injury to the bottom of the big toe, (called the first MTP joint). It is a hyperextension injury that happens when the athlete loads into the joint and pushes off explosively. This bends the big toe into hyperextension, disrupting the plantar plate and other stabilizing structures. Although it may feel like a “small” injury that will pass, it has many structures potentially involved and can get worse if an athlete doesn’t have it addressed. It could potentially affect a number of structures, including the plantar plate, ligaments, and tendons as the base of the 1st MPT joint.

I personally see and treat it the most in football and soccer athletes, since we see a higher risk in sports that have higher volumes of change or direction and cutting.

The best way I can describe turf toe is to imagine a rubber band being stretched to its limit. When the athlete loads and goes to explode, the band snaps.

People don’t realize how important toes are until they are injured. Especially for younger or professional athletes, once the big toe is hurt, it affects not only their sport but day-to-day activities, like walking, because the toe needs to go into extension for those movements.

What Increases the Risk of Turf Toe?

What makes an athlete more likely to get turf toe?
Several factors can increase risk:

  • Playing on turf: the foot or cleat can grab, limiting your foot’s natural motion.
  • Cleat design: Cleat design matters! Too much room or too few spikes in the toe box can change mobility.
  • Heavier athletes- This can mean more stress on joints.
  • Flat feet or foot pronation
  • Certain football positions: running backs, receivers, quarterbacks, defensive tackles
  • Previous foot or ankle injuries

The biggest thing we screen for is loading mechanics! How do you load single leg, are you limited in ankle dorsiflexion or big toe extension?

If the “rubber band” has less capacity to stretch, the likelihood of injury is higher. Athletes who are more rigid are more prone to turf toe.

At the Spooner Sports Institute, we emphasize ankle and big toe mobility for all athletes because it is the first thing that hits the ground and affects mechanics and loading capacity up the chain.

What Are the Different Grades of Turf Toe?

Turf toe injuries are commonly described using three grades. These grades help explain how much the joint has been affected and why treatment can look different from person to person.

Grade one injuries are very mild.
Grade two injuries are more moderate.
Grade three injuries involve a complete tear of the plantar plate.

Because the grade of the injury plays a role in determining the next steps, it’s helpful to review options with a physician, athletic trainer, and/or a physical therapist who can look at what your personal needs are.

Keep in mind, a grade three injury does not automatically mean surgery is necessary! In some cases, treatment may lean more toward surgical repair to help restore stability in the joint. In other cases, support such as a walking boot may be used based on pain levels and activity needs.

For example, someone who needs to walk across a college campus may use a boot to offload the joint and stay mobile throughout the day. Someone with a desk job may not need that level of support. This is why individualized treatment is so important.

What Should Parents or Athletes Do if Turf Toe Happens During a Game?

If turf toe happens during a game, what should athletes (and parents) know?
If an athlete hurts their toe on the field, the first step is evaluation by an athletic trainer. They check for pain, bruising, swelling, and whether the athlete can push off, sprint, jump, and cut safely. The athletic trainer makes the on-the-spot decision about whether the athlete can return to play. They might tape the toe or use a turf toe shank in the shoe to limit hyperextension. It can be uncomfortable, but it helps prevent further injury while the athlete is still playing.

Afterward, a physical therapist evaluates the injury more thoroughly. The physical therapist checks mobility, strength, and function, and guides recovery to restore proper movement and prevent stiffness. Even minor turf toe needs follow-up care. If it’s ignored, the toe can get stiff, movement can be limited, and the risk of reinjury goes up.

Finding the Right Shoe

One of the most important ways to make sure an athlete stays safe is through proper footwear. Sometimes I’ll refer athletes to a specialized sports shoe store for advice. Other times, they just bring in their cleats and even their everyday shoes so we can see how they move and load in each pair. For some injuries, an orthotic might be needed early on to give extra support, and then we take them out of it once it’s not needed. Having both shoes helps us see what the foot is doing in different situations, versus barefoot.

I especially recommend this if someone is getting these injuries repeatedly. Sometimes injuries just happen, but we want to prevent them from happening again. Shoe choice is huge. Getting properly fitted shoes or adding support if needed can help decrease risk and even reduce everyday pain, not just sport-related issues.

I know orthotics and cleats can be expensive, especially for high school athletes. That’s why we make semi-custom orthotics here for a better rate.

If you or your athlete is suffering from turf toe or any kind of pain, schedule an appointment at a Spooner clinic here.