What is turf toe? Causes, symptoms, treatments, and exercises

We’ve all probably stubbed or jammed our big toe at some point. These types of foot injuries tend to be minor and, in most cases, resolve on their own. But for those who play contact sports, like football or wrestling, you may experience a similar type of big toe injury known as turf toe. It’s often caused by — you guessed it — spraining your toe on certain types of artificial turf.

Turf toe is rarely serious, reassures Mijo Cotic, PT, DPT, a physical therapist at Hinge Health. But it may leave you hobbling around for a few days, or even a few weeks. The good news is that you can almost always treat turf toe conservatively at home with exercise therapy and other methods like taping and small tweaks to footwear.

Read on to learn more about what turf toe is, plus tips to heal quickly, including exercises from Hinge Health physical therapists, so you can get back out onto the (artificial) playing field.

What is turf toe?

Turf toe occurs when you sprain the main joint in your big toe. “Turf toe is a hyperextension injury, which simply means that the tiny ligaments of the big toe — the ones you use to push off — have been injured,” explains Dr. Cotic. 

Like any other type of sprain, turf toe can vary in severity. Most of the time, a physical therapist or doctor will “grade” the injury on a scale of one to three to help guide your treatment:

• Grade 1: The ligament is just slightly overstretched.

• Grade 2: There’s a partial tear in one or more ligaments.

• Grade 3: There’s a complete tear of one of the ligaments.

Causes of turf toe

In order to have a better understanding of what causes turf toe, it’s helpful to have a crash course in toe anatomy. 

Your big toe is made up of two joints. The larger one is called the metatarsophalangeal joint (MTP). Right behind it are two small bones called sesamoid bones. These bones help nearby tendons and ligaments move your foot and help your MTP joint bear weight.

When you walk or run, you push off your big toe, which is what allows your weight to shift to the other foot. But if, for some reason, that toe stays flat on the ground — for example, you’re playing a sport where another player tackles you — then that toe will be forced to bend forward heavily, which can cause a sprain, says Dr. Cotic.

Anyone can develop turf toe, but there are a couple things that make you more susceptible:

• Certain sports. Some activities, like football, basketball, and even martial arts, put you at increased risk for turf toe. The intensity of play is a factor too. Research shows that the risk of turf toe is about 14 times higher in actual football games than during practice.

• Certain surfaces. You’re more likely to develop turf toe on an artificial surface, like a football or baseball field, or an outdoor or indoor track. “These surfaces tend to be harder than grass, and shoes like cleats are more likely to stick,” points out Dr. Cotic.

You can also develop turf toe in certain non-sport situations, like if you trip on a stair, but that tends to be much less common, says Dr. Cotic.

Turf toe: a Hinge Health perspective

Traditionally, turf toe has been treated with over-the-counter anti-inflammatories, walking boots or casts, limited activity, and even surgery. But recently, a greater emphasis has been placed on treating turf toe through movement, says Dr. Cotic.

It’s understandable if your first instinct when you experience turf toe pain is to limit your movement. If you’re reluctant to move because you think you’ll cause more damage or injury to your big toe, know this: Movement is often the fastest way to healing. As our Hinge Health care team says, movement is medicine. Movement helps rehab the foot joint by increasing blood flow to the area, and gradually improves the big toe muscle’s strength and flexibility. 

 “You want to keep your foot and ankle moving to help muscles stay strong and prevent stiffness,” Dr. Cotic explains. “But you want to make sure you move in a helpful way. Certain movements can put more strain on your foot muscles, tendons, and ligaments and may actually make turf toe symptoms worse.” That’s why physical therapy, with its targeted exercises and stretches, is a good idea if you have turf toe pain. Together, you and your physical therapist can come up with a plan to ease your symptoms. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Symptoms of turf toe

Symptoms of turf toe vary depending on the intensity of the sprain, says Dr. Cotic. But in general, here are signs of a turf toe injury:

• Pain and tenderness in the big toe joint. “You may feel discomfort all the time, or only when you do an activity like walking that requires you to push off your big toe joint,” explains Dr. Cotic.

• Swelling and bruising along the base of your big toe. These are classic sprained toe symptoms.

• Stiffness. You may find that you can’t wiggle your big toe as easily as before.

• Difficulty or pain when pushing off. This could be to take off sprinting or simply pushing up out of a chair. 

• Instability when bearing weight on the affected toe joint. 

Treatments for turf toe

Turf toe treatment depends, in part, on how severe the sprain is. But most of the time, it can be treated conservatively with activity modification, ice, exercise, and physical therapy. Here’s what physical therapists at Hinge Health recommend:

• Ice. For the first 48-72 hours, ice will help to relieve inflammation in the big toe, says Dr. Cotic. After that, you can continue to ice, or switch to heat if that feels better for you.

• Walking boot. If you have a severe sprain, you may benefit from a walking boot or cast for a short time to provide support and keep your big toe in a partially pointed down position.

• Physical therapy. A physical therapist (PT) can recommend exercises and stretches to help ease symptoms. “Even if you have a severe sprain, you’ll want to start physical therapy right away,” says Dr. Cotic. “Early movement is essential to keep the muscles around the joint strong and prevent joint stiffness.” A PT can also give you advice on activity modification. Many people can return to their regular activities right away after a toe injury, but activity modifications can help make you more comfortable. 

• Taping. Turf toe taping can be particularly helpful if you want to return to sports right away. Taping can help stabilize the toe and foot in order to prevent aggravating the injury as you move. A PT can show you how to do it on your own.

• Turf toe plate. This is a type of over-the-counter shoe insert that reduces the range of motion in your big toe joint. “It limits the ability for your big toe to push off, which is what may be causing you pain,” explains Dr. Cotic. Your PT can also recommend an over-the-counter orthotic that has good toe support.

• Exercise. A more severe sprain may mean that you can’t return to high-impact sports like running or football right away. But you still want to do some form of exercise to encourage blood flow to the area, says Dr. Cotic. Low-impact activities like biking, swimming, or using the elliptical can help you stay active without irritating your big toe. “Some discomfort is okay, but you don’t want to push through unacceptable levels of pain,” he explains.

If you play a competitive sport, research suggests that you should be able to return to it within a week after a mild sprain. A moderate sprain might require a couple weeks, while a severe sprain could take a month or more. Everyone heals at different rates, so treat these timelines as estimates and don’t rush your recovery. But remember: The sooner you get into physical therapy, the faster you’ll be able to get back on your feet, says Dr. Cotic.

These exercises are recommended by Hinge Health physical therapists to to help treat turf toe pain and improve strength, balance, and flexibility in your big toe, foot, and lower body. Because your feet don't act alone, you need to strengthen all the structures that support them in order to take pressure off the big toe joint so it can heal. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT tip: Check your workout shoes

There's no such thing as the “perfect” shoe that works for everyone. But, in general, athletes healing from turf toe may do well with a sneaker that has a stiffer toe break, advises Dr. Cotic. “This allows your foot to rock forward, versus pushing through your toe joint,” he explains. “It can be good in the short term to help with recovery, and, longer term, can prevent turf toe from reoccurring.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Waldrop, N. E. (2021). Assessment and Treatment of Sports Injuries to the First Metatarsophalangeal Joint. Foot and Ankle Clinics, 26(1), 1–12. doi:10.1016/j.fcl.2020.07.003

2. Gupta, A., Singh, P. K., Xu, A. L., Bronheim, R., McDaniel, C., & Amiethab Aiyer. (2023). Turf Toe Injuries in the Athlete: An Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Current Reviews in Musculoskeletal Medicine, 16(11), 563-574. doi:10.1007/s12178-023-09870-y

3. George, E., Harris, A. H. S., Dragoo, J. L., & Hunt, K. J. (2013). Incidence and Risk Factors for Turf Toe Injuries in Intercollegiate Football. Foot & Ankle International, 35(2), 108–115. doi:10.1177/1071100713514038

4. Aran, F., Shamrock, A. G., & Scott, A. T. (2020). Turf Toe. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507810/

5. Fields, K. B., & Atkinson, B. (2024, February 13). Evaluation, diagnosis, and select management of common causes of forefoot pain in adults. UpToDate. https://www.uptodate.com/contents/evaluation-diagnosis-and-select-management-of-common-causes-of-forefoot-pain-in-adults#H2787992174