The Truth About Turf Toe

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With football season in full swing, most of the injury talk revolves around ACL tears and concussion protocols. One overlooked injury that tends to occur more often, especially with football players, is the injury known as turf toe.  Although it seems minor, an injury to the 1st MTP (big toe) can lead to other subsequent foot, ankle, knee and hip injuries.

What is turf toe?
In its simplest definition, turf toe is the hyperextension (over-extension) of the big toe joint.  This can lead to stretched ligaments and even cause a fracture of the small bones (sesamoid bones) of the big toe joint.

How does it happen?
The mechanism of injury usually resulting in turf toe injuries is most commonly seen when the forefoot (front of the foot) is fixed on the ground, the heel is raised, and a force pushes the big toe into hyperextension. This is mostly seen in American football players, but has also been linked to martial arts, runners, gymnasts, dancers and basketball players.

What can be the implications of this injury?
To most, it would seem that a sprain of the big toe is a mundane injury that can be fixed with rest. While rest is a large component of the healing process, the long-term implications of this injury, if not properly addressed, can be more detrimental than you think.

The big toe plays a crucial role in balance and stability during walking, jogging and running. As the weight is transferred from the heel to the front of the foot, the big toe acts as a lever to allow the foot to push off the ground. An injury to the big toe can alter the entire leg mechanics, leading to compensatory strategies up the entire kinetic chain.

  • Excessive foot supination

Landing on the outer half of the foot can cause increased stress on the 3rd, 4th and 5th foot bones, which can lead to stress fractures.

  • Increased knee flexion

Inability to use the big toe during push off can result in the inability to fully extend the knee, thus absorbing additional force at the knee while decreasing the power of your stride.

  • Decreased hip extension.

With decreased big toe extension and lack of knee extension, the hip is the next area for compensatory mechanisms.  While trying to compensate for lack of motion and improve power, the hip can laterally rotate (turn out), putting additional stress and force on the outer aspect of our leg, thereby altering mechanics further. The outer leg muscles become over stressed, leading to muscle imbalances and lack of stability.

In conclusion, an injury to the big toe of the foot can be complex and lead to other injuries. It is important that a medical professional examines an injury to ensure proper management and recovery.

References:

  1. http://www.foothealthfacts.org/Content.aspx?id=1479
  2. http://orthoinfo.aaos.org/topic.cfm?topic=A00645
  3. https://runsmartonline.com/articles/strength/first-toe-mtp-extension-on-running-mechanics/