Sprains, strains, stubs, and breaks, the toes can sustain a lot of injuries and insults. A sprained toe can sideline you from your sport or just make it challenging to get around. In this guide, learn how to recognize, treat, and heal a sprained toe, especially, learn options to heal the dreaded turf toe, the plague of many NFL players.

Anatomy Of The Foot

The foot has a complex anatomy which gives it strength, stability, and flexibility. Except for the big toe, each toe has the following three joints:

• Metatarsophalangeal joint (MTP): Where the toe joins the rest of the foot
• Proximal interphalangeal joint (PIP): The joint in the middle of the toe
• Distal interphalangeal joint (DIP): The joint furthest from the foot

The big toe with only two bones has only a metatarsophalangeal joint and an interphalangeal joint.

The Plantar Complex

The metatarsophalangeal joint is a complex joint that must balance stability with flexibility. An injury to this joint, such as a sprained toe, can be challenging to treat and to heal. According to the American Academy of Orthopedic Surgeons, the ligaments, small bones, and fibrous tissues that make up the MTP joint are called the “plantar complex.” They include the following structures:

• Plantar plate: A band of thick, fibrous tissue that stabilizes the MTP joint from below to keep it from bending too far towards the top of the foot (dorsiflexion).
• Collateral ligaments: Stabilizes the MTP joint on the sides to keep it from going too far side-to-side.
• Flexor hallucis brevis: A tendon that runs under the big toe and provides support and stability to the toe during push-off motions.
• Sesamoids: Two small bones that are embedded in the flexor hallucis tendon to provide stability to the MTP joint and to help the tendon move more easily.

Diagnosing A Sprained Toe

Toe sprains occur when ligaments in the toes have been overstretched or damaged. It is a common injury that results from stubbing the toe on the ground, getting the toe caught while walking, or hitting a nonyielding object with a kick. The pain, swelling, and bruising of a sprained toe can be difficult to differentiate from a toe fracture. A health care provider may order an x-ray or magnetic resolution imaging (MRI) to diagnose and treat a sprained toe correctly.

Sprains are classified by severity into the following:

• Grade 1 sprain: Slight stretching and some damage to the fibrils that make up the ligament
• Grade 2 sprain: Partial tearing of the ligament resulting in a joint that is abnormally loose when moving.
• Grade 3 sprain: A complete tear of the ligament leading to an unstable joint that makes the joint non-functional.

Treating A Sprained Toe

The initial steps to treat and heal a sprained toe include the following:

• Rest: Take a break from the activity that caused the injury. Avoid walking on the injured foot.
• Ice: Apply an ice pack wrapped in cloth for 20 minutes several times a day. Remove if the skin becomes numb.
• Compression: Wrap an elastic bandage around the injured foot to decrease swelling.
• Elevation: Elevate the foot above the heart to further decrease swelling.
• Anti-inflammatory Medications: Ibuprofen may provide some pain relief and decrease inflammation.
• Taping: Taping the big toe to other toes to restrict movement may allow a sprained toe to heal more quickly.

Preventing Injury

Even more important than healing a sprained toe is preventing it in the first place. Exercise the feet to attain a good range of motion, strength, and stability. Wear supportive athletic shoes that have enough room in the toe box. Avoid kicking any nonyielding objects to prevent further injuries.

What Is Turf Toe?

Turf toe is a sprain of the main joint in the big toe. It happens when the toe is hyperextended and there is an injury to any of the structures making up the plantar complex. Toe positions include the following:

• Neutral position: The toes are in line with the rest of the foot
• Plantar flexion: The toes curl under towards the sole
• Dorsiflexion: The toes are pulled up towards the top of the foot. Hyperextension occurs when the toe is dorsiflexed too far.

According to Poppe et al., artificial turf is stiffer than grassy surfaces and does not have as much flex or give to it. As many as 45% of football players playing on artificial turf suffer from turf toe. Soccer, basketball, and wrestling participants may also suffer from turf toe.

“It’s not anything like Antonio’s injury,” Tomlinson said. “Antonio came out in a boot after the game. It’s not that bad. People don’t need to freak out.”

LaDainian Tomlinson comments after his “turf toe” injury

Diagnosing Turf Toe

The injury from turf toe can range from a stretching injury to full dislocation. Hyperextension of the big toe can lead to metatarsophalangeal joint (MTP) injuries. The forefoot sticking to the turf at the start of a sprint and an opponent landing on the heel while the toes are hyperextended can both lead to hyperextension injuries. Grading the soft tissue injuries are as follows:

• Grade 1: Stretching injury which causes slight swelling and pin-point tenderness in the tissue of the plantar complex.
• Grade 2: A partial tear which causes swelling, bruising, and more widespread tenderness, limiting movement of the toe.
• Grade 3: The plantar complex is completely torn, resulting in severe tenderness, swelling, and bruising, making it painful and difficult to move the toe.

A health care provider will examine the toe and stress the soft tissue structures supporting the toe to test the strength and stability of the plantar complex. The health care provider may request weight-bearing X-rays and magnetic resonance imaging (MRI) to evaluate the injury fully. The treatment to ensure proper healing of a sprained toe differs from a bone fracture.

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Treatment Options To Heal Turf Toe

According to the American Academy of Orthopedic Surgeons, your health care provider may recommend the following strategies to heal “turf” toe:

Grade 1 Injury

• Rest: Take a break from the activity that caused the injury. Avoid walking on the injured foot.
• Ice: Apply an ice pack wrapped in a cloth for 20 minutes several times a day. Remove if the skin becomes numb.
• Compression: Wrap an elastic bandage around the injured foot to decrease swelling.
• Elevation: Elevate the foot above the heart to further decrease swelling.
• Anti-inflammatory medications: Ibuprofen may provide some relief for the symptoms.
• Taping: Taping the big toe to other toes to restrict movement.
• Orthotics: Wearing a thin, graphite shoe insert with a rigid forefront component to reduce stress on the plantar plate and to stabilize the forefoot.

Grade 2 Injury

• Prescribe a walking boot to immobilize the joint for up to a week and then revert to the strategies used to treat a grade 1 toe sprain.
• Rest for 3-14 days before returning to sporting activities.

Grade 3 Injury

• Immobilize the foot using a walking boot or a cast for several weeks. Gradually step down treatment to the recommendations given for a grade 2 and then grade 1 injury.
• Physical therapy to strengthen and stretch the toe ligaments and tendons.
• Surgery if the grade 3 injury is severe.

Long-term Outcomes For Healing A Sprained Toe

Diagnosing and treating turf toe early in the injury progression typically result in better outcomes. However, after healing from the acute injury resulting in a sprained or “turf” toe the following symptoms may persist:

• Pain and joint stiffness
• Lack of push-off strength
• Stiffness
• Bunions
• Cocking of the big toe

A sprained toe is painful and can adversely affect your quality of life. Treatment options continue to increase. Seeking treatment quickly is more likely to lead to a speedy recovery. Invigor Medical, a US-based provider stands ready to help.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

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