Big muscles get a lot of attention in the world of physical activity, but there’s a part of your body responsible for your very balance while walking upright and we barely notice it. Barely, that is, until something goes wrong.
Turf Toe is a small injury that can ultimately put you out. If your toe screams in pain every time you walk, you aren’t going to get much done, are you? You’ve got Turf Toe.
The name comes from football where players frequently stress those ligaments running at full speed on artificial turf. It’s not limited to football, however. All repetitive, forceful movements put you at risk.
The affected area is the metatarsophalangeal joint, or MTP. It connects the foot bone to the bone in the first toe. The sprain occurs, and sufferers feel pain, loss of movement, numbness at times, and swelling. The symptoms rarely happen all at once, usually developing over a period of time.
Medical practitioners diagnose the condition in three grades of severity. Grade one is the mildest with some tenderness and swelling, but no tearing. Usually, careful wrapping and rest is the answer.
Grade two is a little more severe. There is partial tearing in addition to MTP spraining. Symptoms are more pronounced with pain and swelling. There may also be bruising at the injury site. Typically, treatment is two weeks of rest at least to allow the symptoms to subside and medical professionals to reevaluate the extent of the injury.
Grade three is the most severe. This is a complete tear with the patient unable to put weight on the foot at all. Several weeks of immobilization plus extensive orthopedic care is necessary to heal the injury and prevent further tearing.
Let’s take a look at a few standard treatments that help ease symptoms and ensure you’re back on your game soon.
1.R (Rest) I (Ice) C (Compression) E (Elevation)
R Rest I Ice C Compression E Elevation treatment is a common starting point for all kinds of injuries. It’s a critical component of heading off any sports injury before you even seek medical attention.
(R) First, stop what you’re doing. Pain can be a threshold, but it’s also your body’s way of telling you to stop. Don’t think you’ll be better off if you push through the pain.
(I) Next, apply ice to the affected area. It can temporarily relieve the pain you’re feeling and help you get a handle on the swelling as it begins. Be careful not to cause injury to your skin through extended exposure to freezing, however. A good rule of thumb is 20 minutes on and 20 minutes off. Regularly assess the swelling to see if further ice treatments are necessary.
(C) After ice, compression helps immobilize the injury site, so you don’t further strain it. The most common method is taping. Using athletic or KT tape, stretch the toe towards the shin as much as is comfortable. Take a thin piece of tape and wrap it around the toe, applying tension, but be careful not to cut off circulation. Take a long piece of tape and attach it from the base of your heal to the edge of the toe.
If you aren’t using KT tape, also tape the next biggest toes to your big toe to prevent movement.
(E) Elevate the foot at 45 degrees to prevent blood from pooling in the area and to further reduce swelling. This is part of the rest component as well, allowing your injury to heal on its own.
2. Nonsteroidal Anti-Inflammatory Medications
NSAIDs are a highly effective treatment for minor cases of Turf Toe. Some of these you have in your cabinet. Aspirin and Ibuprofen (found in Advil, for example) help provide pain relief and also reduce swelling at the injury site.
Other types of NSAIDS very effective for this injury are Emflex (Acemetacin), Naproxen or Naprosyn, Diclofenac, and Tiaprofenic Acid (Surgam). Many NSAIDs can be purchased over the counter.
For minor injuries, you can complement these NSAIDS with foods also known for reducing inflammation, such as salmon, olives and olive oil, kale, almonds, and blueberries. The effects of these foods are slow acting and might not be enough to take on their own.
3. Toe Protection
Protecting the injury site allows you to continue with your exercise regimen in the case of mild, grade one Turf Toe or allow the toe to fully heal without further complications in the case of more severe cases.
Orthotics are a standard way to protect the toe. Rigid inserts in the shoes prevent movement and support the toe during activity. Flexible shoes that allow for the overextension of the toe are out of the question until the site heals.
These inserts are usually graphite or carbon fiber and prevent any flexing of the toe during movement. You may have to rethink the way you move, but your toe won’t be in danger of repeating the same over-flexion that caused the injury in the first place.
4. Immobilization
For severe injuries, complete immobilization may occur. Taping the big toe to the other toes can prevent movement while training, but this should only be done in cases of very mild injury. Extended taping can affect the circulation of the big toe, so this option isn’t a long-term solution.
For grade two and grade three injuries, some medical practitioners recommend a boot or a brace to prevent movement. These usually prevent you from training until the toe heals.
Splints offer the most support, but it’s nearly impossible to move around while wearing them. Splints are usually reserved for the most severe injuries, in which you need full rest in addition to medical intervention.
5. Range Of Motion Exercises
Grade three injuries will require some physical therapy. Grade one and grade two injuries do benefit from these exercises as a preventative measure. Foot stretches, where you bend the foot and splay the toes away from the body and then bend the foot towards the body while curling the toes, are helpful.
You can also practice picking up small objects with your toe up to three times a day to extend the motion of your big toe. Toe curls, where you sit down and pick up a towel and then extending your legs to a holding position for ten seconds, are another way to help.
6. Time Off From Sports Activity
Grade one injuries are the only ones where you can adequately protect the toe and still train. Grades two and three require time away from all activity to allow the foot to recover.
Grade two injuries frequently need one to two weeks to fully recover. This means elevation, slowly incorporating range-of-motion exercises as your medical practitioner advises, and doing light exercises towards the end of the time off period.
Grade three injuries require even more time off. These usually need several weeks of rest along with boots or other devices to prevent movement while completing activities like walking (non-exercise related).
7. Adjust Footwear
Grades one and two often use something called “Morton’s Plate” within footwear to provide extra protection. It’s a graphite or carbon fiber plate that extends along the affected joint for more support and to limit possible motion.
Individual orthotics often have this plate as the primary insurance against stressing that joint by accidentally overextending it the way the original injury was caused. For more severe injuries, adjusting the footwear isn’t enough, and many sufferers will have to wear a medical boot rather than altering existing footwear.
Many sports shoes are too flexible to prevent further injury to the site, and it’s too risky to go without adjustment.
8. Immobilization
Grade one is the only one that gets away with continuing light training with modification. The key to grade two and three healing is complete immobilization. Boots that prevent any flexing of the foot or the toe cut down on stress to the injury site until the partial or full tear heals.
With grade three injuries, the boot or splint may be needed for up to eight weeks until the tear heals fully. Most people won’t have to have surgery to correct the injury, but this is dependent on honoring immobilization.
Each time you go out without the immobilization, you risk tearing the site again and extending your healing time.
9. Progressive Movement And Exercises
In addition to range-of-motion exercises, most medical practitioners require grade two, and three injury sufferers begin with light exercises that limit weight on the injury site. Swimming or cycling are examples of these first types of exercises because very little pressure is put on the injury site.
Toe taping is a significant part of this. Once your medical practitioner has given the green light, you can proceed with more complex movements that put weight on the toe such as running. If you train using jumping or pivoting movements, these will come last once the toe heals.
