Turf toe is a sprain of the main joint at the base of the big toe, known as the first metatarsophalangeal (MTP) joint. This injury occurs when the big toe is forcefully bent upward, often during activities that involve running, jumping, or sudden changes in direction. Common symptoms include sudden pain, swelling, bruising, and difficulty moving the big toe. In more severe cases, people may experience significant tenderness, loss of push-off strength, joint stiffness, and trouble bearing weight on the affected foot.

Turf toe is most frequently seen in athletes, especially those who play football, soccer, basketball, and other sports on artificial turf or hard surfaces. Among collegiate athletes in the United States, turf toe is one of the most common foot injuries. The condition is particularly prevalent in football players. About one-third of professional football players report having experienced turf toe, and over 80% of these injuries occur on artificial turf.

Fortunately, turf toe can be managed effectively with proper treatment. Most people recover fully and return to their previous level of activity, especially when the injury is diagnosed early and managed appropriately.

Turf toe refers to a sprain of the supportive soft tissue structures that surround the MTP joint, the primary joint of the big toe. This joint is where the long bone of the foot (the metatarsal) meets the first bone of the big toe (the phalanx). The MTP joint is stabilized by the plantar capsuloligamentous complex, which includes several soft tissues: the plantar plate (a thick band of tissue under the joint), collateral ligaments on each side, and tendons. Along with two small bones called sesamoids, these soft tissue structures keep the joint stable and allow the big toe to bend and push off the ground during walking, running, and jumping.

Turf toe occurs when one or more of these soft tissue structures become stretched or torn, most often due to a forceful upward bend of the big toe. This injury can range from mild stretching of the soft tissues to partial or complete tears, and in severe cases, even dislocation of the joint. When these stabilizing tissues are damaged, the joint becomes painful, swollen, and hard to move. People with turf toe may have difficulty pushing off with the affected foot. They may also experience reduced agility and notice swelling or bruising around the base of the big toe. In more severe cases, there may be significant loss of motion, weakness, or deformity in the toe.

Turf toe can affect people of any age. If not recognized and managed properly, turf toe can lead to chronic pain, stiffness, and long-term problems with foot function.

To determine the most effective treatment, doctors classify the severity of turf toe injuries into three grades. This classification is based on the extent of damage to the plantar complex and the resulting symptoms.

• Grade 1: This is a mild injury where the plantar complex is stretched or strained. The big toe MTP joint remains stable. It typically causes localized tenderness and slight swelling, but the person can usually bear weight and has a normal range of motion.
• Grade 2: This grade involves a partial tear of the plantar complex. It is characterized by moderate swelling, visible bruising, and more diffuse tenderness. The toe may be somewhat unstable and painful, with restricted motion, and people may have difficulty bearing weight.
• Grade 3: This is the most severe grade of turf toe, involving a complete tear or rupture of the plantar complex. In this grade, the big toe MTP joint is typically unstable. It causes significant pain, swelling, and bruising, making it difficult or impossible to move the big toe or bear weight on the foot. Grade 3 injuries may also involve associated injuries such as a sesamoid bone fracture or joint dislocation.

Turf toe is caused by a forceful upward bending (hyperextension) of the big toe at the MTP joint. This typically happens when the ball of the foot is planted firmly on the ground, and the person raises their heel and pushes off with strong force, bending the big toe beyond its normal range of motion. The injury often occurs during activities that involve running, jumping, or sudden changes in direction, especially when an athlete’s foot remains on the ground while the rest of the body moves forward.

The risk of turf toe increases on artificial turf surfaces, which are less shock absorbent than natural grass, making it easier for the big toe to be forced into hyperextension. Body weight and foot structure can increase the risk of developing turf toe. Footwear can also play a role. Shoes with flexible soles or less support in the toe box can make the joint more vulnerable to injury. While turf toe happens most frequently when playing football, it can also occur in other sports such as soccer, basketball, gymnastics, wrestling, and dance, or in any activity where the big toe can be jammed or forcefully bent upward.

Risk factors for turf toe include:

• Playing on artificial turf surfaces
• Participation in sports such as football, soccer, basketball, wrestling, gymnastics, and dance
• Use of shoes with shorter or fewer cleats, flexible (rubber) soles, and/or increased toe box flexibility
• Increased athlete body weight
• Increased foot pronation
• Player position (for example, running backs, quarterbacks, wide receivers, and defensive tackles in football have higher rates of injury)
• Prior first metatarsophalangeal (MTP) joint injury
• Abnormal structure or shape of the bones of the foot
• Limited ankle or big toe range of motion
• Longer duration of professional sports participation

Symptoms of turf toe may include:

• Sudden pain at the base of the big toe
• Swelling around the big toe joint
• Bruising around the base of the big toe
• Tender to touch
• Difficulty or pain when moving the big toe
• Limited range of motion in the big toe
• Difficulty bearing weight on the affected foot
• Loss of push-off strength
• Stiffness in the big toe joint
• Weakness or instability in the big toe
• Reduced agility or trouble with running, jumping, or cutting movements
• In severe cases, deformity or dislocation of the big toe joint

To diagnose turf toe, your doctor will review your medical history, conduct a physical exam, and order one or more diagnostic tests.

Your doctor may ask you about how the injury occurred, your symptoms, when they began, and whether you have had previous injuries to the big toe. During the physical exam, your doctor will check for swelling, bruising, tenderness, and range of motion in the big toe joint. They may move your toe in different directions to assess for pain, instability, or weakness, and compare the injured toe to the uninjured side. Special tests, such as the Lachman test (which checks for up-and-down instability) and varus or valgus stress tests (which check for side-to-side stability), may be performed to evaluate the integrity of the joint and supporting structures.

Additional tests may be used to make a diagnosis and rule out fractures or other causes of symptoms, including:

• X-rays: Used to rule out fractures, assess joint alignment, and look for changes in the position of the sesamoid bones or small bone fragments.
• Magnetic resonance imaging (MRI): Provides detailed images of soft tissues, such as the plantar plate, ligaments, tendons, and cartilage, and helps determine the extent of the injury.
• Ultrasound: May be used to assess the plantar plate and other soft tissue structures, and to check how stable the joint is during movement, though its accuracy depends on the operator.
• Computed tomography (CT): Sometimes used in addition to X-rays to evaluate bone injuries.

These tests help your doctor confirm the diagnosis, determine the severity of the injury, and guide treatment planning.

Most cases of turf toe, particularly the majority of Grade 1 and 2 injuries, can be managed without surgery, and treatment is tailored to the severity of the injury. The main treatments for turf toe include:

• Rest, ice, compression, and elevation (RICE): These steps help reduce pain and swelling in the early stages after injury.
• Immobilization: For mild injuries, taping the big toe to the second toe or using a stiff-soled shoe can limit movement. More severe injuries may require a walking boot or cast to stabilize the unstable MTP joint and allow healing.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help relieve pain and reduce swelling.
• Physical therapy: As symptoms improve, gentle stretching and strengthening exercises restore flexibility, strength, and range of motion in the big toe.
• Protective footwear or orthotic inserts: Stiff-soled shoes or special orthotics or inserts can help protect the joint and prevent further injury during recovery and return to activity.
• Surgical treatment: Surgery is frequently used for Grade 3 injuries due to the high likelihood of joint instability and associated structural damage, such as complete tears of the plantar plate or fractures of the sesamoid bones. Surgery is also considered when symptoms fail to improve with conservative treatment. The goal of surgery is to repair damaged tissues and restore joint stability.
  
  

Treatment plans are tailored to the severity of the injury and the needs of the individual. Most people are able to return to their previous level of activity after proper care and rehabilitation.

People with turf toe may be at increased risk for certain complications, especially if not diagnosed and treated early. These include:

• Chronic pain in the big toe joint: Ongoing discomfort that can limit activity.
• Joint stiffness: Reduced flexibility and range of motion in the big toe.
• Loss of push-off strength: Weakness when pushing off the foot during walking or running.
• Decreased athletic performance: Difficulty with running, jumping, or changing direction.
• Arthritis or degenerative joint changes, such as hallux rigidus: Wear and tear over time can lead to toe arthritis, stiffness, or loss of function.
• Hallux valgus (bunion): Outward turning of the big toe, sometimes leading to a visible bump.
• Cock-up deformity: Persistent upward extension of the big toe.
• Joint instability or deformity: Ongoing looseness or abnormal positioning of the big toe joint.
• Loose bodies in the joint: Small fragments of bone or cartilage within the joint space.
• Tendon injuries: Such as tears in the flexor hallucis longus tendon.
• Need for surgical intervention: Surgery may be required if complications develop or if the injury does not heal properly.

The outlook for people with turf toe varies depending on the severity of the injury, how quickly it is diagnosed and treated, and whether complications develop. Most people with mild or moderate injuries recover fully with proper care and can return to their previous level of activity. Athletes with low-grade injuries often resume play within days to weeks, and most achieve their prior level of performance. However, more severe injuries may require longer recovery times, and some individuals may experience ongoing symptoms such as pain, stiffness, or reduced push-off strength.

When turf toe is not diagnosed or treated promptly, long-term complications such as joint stiffness, chronic pain, arthritis, or deformity can develop. Severe injuries may be season-ending or even career-ending for athletes. While most people recover well with appropriate treatment and rehabilitation, up to half may have some persistent symptoms. Early recognition, proper management, and a gradual return to activity are important for the best possible outcome.

Yale Medicine’s Orthopaedic Foot and Ankle Division offers advanced diagnostic and treatment options for a wide range of foot and ankle conditions, including turf toe. Our team utilizes state-of-the-art imaging to make a diagnosis, and if surgery is needed, our highly skilled surgeons perform a full spectrum of procedures, from minimally invasive arthroscopic techniques to complex foot reconstructions.

“We provide comprehensive nonsurgical care, including physical therapy, athletic training, and innovative biologic treatments to promote healing conservatively,” says Irvin Oh, MD, chief of orthopaedic foot and ankle surgery at Yale Medicine. “Our providers are also experts in assessing and addressing underlying foot deformities that may contribute to this condition. In collaboration with the orthopaedic sports medicine team, we offer the most comprehensive and coordinated management to support recovery.”

Yale Medicine’s orthopaedic experts emphasize personalized care, tailoring treatment to each patient’s goals, especially for those needing to return to work or sports quickly. “Guided by the latest scientific evidence and available resources, we are committed to helping our patients recover fully and safely resume their physical and athletic activities,” Dr. Oh adds.