A Guide to Physical Therapy for Turf Toe
Turf toe (TT) is a common injury in athletes, especially those who play football, soccer, or other sports on artificial turf surfaces. It can be excruciating and can keep you out of the game.
In this guide, we will discuss the causes of injury, symptoms, and conservative treatment options — primarily turf toe physical therapy. Working with a CityPT physical therapist is the best line of defense to get you back to your sport as soon as possible.
Turf toe injuries were first coined in the 1960s when athletes that practiced and played games on artificial turf sustained a higher number of toe injuries.1
- What is Turf Toe?
- Causes of Turf Toe
- What Does Turf Toe Feel Like?
- Diagnosing Turf Toe Injury
- What to Expect: Physical Therapy for Turf Toe
- When Does Turf Toe Need Surgery?
- Prevention Tips for Turf Toe Injury
- Don't Let Injury Slow You Down
A turf toe injury is a sprain of the joint where the big toe meets the foot, also known as the metatarsophalangeal joint or MTP joint. Tissues that provide stability to this joint and can be injured include:
- Local ligaments, particularly the plantar complex (the bottom of the toe)
- Muscles of the foot, particularly the hallicus brevis (injury here is technically considered a strain)
- Small bones at the base of the MTP joint that act as pulleys for forward momentum, known as the sesamoid bones
TT results when the big toe is forced into hyperextension at the MTP joint. Since the entire foot and big toe plays a vital role in helping you push off when you walk or run, this injury can be debilitating if not treated properly.
TT can result in three different grades of injury, ranging from a sprain to a complete tear of the plantar complex ligament.
TT injuries often occur when a player's foot is planted firmly, and their body continues moving forward. It is most common on artificial turf due to extra traction on this type of playing field.
Turf toe, or MTP hyperextension, can also occur with:1
- Jamming the toe while playing a sport, such as football or soccer
- Running into something hard, such as a goal post or another player
- Landing on the foot awkwardly after jumping
- Chronically jumping or running, particularly in flexible shoes
- Another player lands on your heel during a contact sport
- Wearing highly flexible soles while playing high-impact sports
TT symptoms can vary depending on the grade and severity of the injury.
Symptoms may include:2
- Localized pain and tenderness to touch along your first toe or forefoot
- Swelling in the big toe or forefoot
- Painful motion with walking, running or jumping when the foot pushes off the ground
- Difficulty moving the big toe or feeling of instability
- Cramping of the arch
- A popping sensation at the time of injury
- Bruising around the big toe or forefoot
- Decreased range of motion and stiffness of the MTP joint, particularly with big toe extension
- Impaired muscle function of the toes and foot, causing a change in gait pattern (walking)
If you suspect you have TT, it's important to see a medical professional as soon as possible. A CityPT clinician can assess your injury for functional deficits and help you create a treatment plan to promote healing and a full return to your activities.
Suppose your physical therapist is concerned about a severe tear, fracture, or another type of foot or ankle injury. In that case, they can refer you to your physician for further imaging and diagnostic testing if needed. Conditions they should rule out include sesamoiditis, fracture, and gout.
Physical therapy treatment will vary depending on the grade and severity of the injury. The main focus of therapy is to reduce pain, inflammation, and swelling while promoting healing.
Your physical therapist may:
- Prescribe orthotics or other devices — such as a splint or walking boot — to immobilize the toe initially
- Perform manual therapy techniques to reduce pain and swelling while improving range of motion tolerance
- Prescribe exercises to improve toe, foot, and ankle motion, strength, and coordination
- Use modalities such as ice, electrical stimulation, or ultrasound to reduce pain and swelling
- Teach you how to properly tape or brace the toe for protection during high-impact activities and restrict painful motion temporarily
- Patient education about your injury, how to best manage it, and how to prevent further aggravation in the long-term
Most patients with TT will see significant improvements within four to six weeks when working with a physical therapist. However, some may require up to twelve weeks of sports physical therapy.
Common Turf Toe Physical Therapy Questions
Let's review some questions that are commonly asked by patients in our clinics:
Does physical therapy help turf toe?
Yes. The American Physical Therapy Association (APTA) recommends working with a physical therapist to reduce pain and swelling associated with turf toe by providing support for the injured joint. Plus, they will help get back to your sport as soon as possible while reducing the risk of further injury.
How long is rehab for turf toe?
As mentioned above, you can expect to work with your CityPT physical therapist within four to six weeks. Because turf toe is a sprain, rest and physical therapy are both important components in recovering from this injury.
What is the fastest way to cure turf toe?
Guidance from a CityPT physical therapist that specializes in sports (orthopedic) turf toe rehab.
Should you stretch your toe if you have turf toe?
Whether you can stretch your toe depends on the severity of your injury and what stage of recovery you are in. For the best answer, talk to a specialist at CityPT.
Can walking make turf toe worse?
Walking can be difficult with pain caused by turf toe. A treatment program and education from a physical therapist on how to walk and what to avoid will help you avoid injury aggravation.
Turf Toe Exercises to Try
Let's review some favorite exercises from physical therapists, including range of motion exercises and muscle strengthening exercises. However, proceed with caution and ask for help if you have any questions.
- Self-massage of surrounding structures to promote blood to the foot for healing
- Gentle toe strengthening, such as toe scrunches, marble pickup, and drawing with the toes
- Foot and toe range of motion, including pain-free toe extension and ankle rolls
- Functional training, such as calf raises, single leg balance, lunges, and jumping (a final stage when the toe is pain-free)
In most cases, TT can be treated conservatively with sports physical therapy.3 Surgery is typically only recommended if you have a complete tear of the plantar plate or another ligament and your toe remains unstable despite conservative treatment. Injections or other medication may be needed initially for pain relief. You can talk to your orthopedic doctor or other trusted healthcare providers.
While certain external factors cannot be controlled, there are several things you can do to prevent TT or reduce your risk of further injury:2
- Wear shoes that fit well and support the foot, particularly during high-impact activities
- Practice keeping the foot flat when landing from jumping or pivoting rather than on an extended toe
- Use tape or braces when participating in activities that put you at risk for TT
- Strengthen the muscles around the foot and ankle to keep local tissue extensible and tolerant of the demands placed on them
- Improve your flexibility, particularly in the feet and calf muscle groups
- Vary the surfaces you are practicing on (when possible) — soft grass is more forgiving than turf
- Take frequent breaks from high-impact activities to reduce repetitive lower-body strain
- Implement cross-training a few days per week to balance your training load
- Do not play through pain. If you experience any pain or discomfort, see a CityPT professional as soon as possible
- Make healthy lifestyle choices to maximize our tissue health and the body's ability to heal — this might include better sleep, a nutritious diet, mental health care, etc.
Ignoring toe pain or trying to "work through it" can worsen your injury and delay the healing process.
If you have turf toe, or are experiencing any pain in your toe, foot, or ankle, choose a CityPT specialist today and schedule an appointment. We'll help you get back on your feet and feel your best as soon as possible.
This guide is intended for informational purposes only. We are not providing legal or medical advice, and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Robert B. Anderson, MD, Kenneth J. Hunt, MD, Jeremy J. McCormick, MD -Management of Common Sports-related Injuries About the Foot and Ankle, Journal of the American Academy of Orthopaedic Surgeons 2010; 18: 546-556 ↩ ↩2
Freddie H. FU, M.D , David A.Stone, M.D. –Sports Injuries Mechanisms Prevention Treatment – Williams & Wilkins (1994) p. 620 ↩