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Big Toe Pain: Turf Toe Injury

Several things can cause great toe pain: arthritis, injury to the bone, and soft tissue. A turf toe injury is when the bottom of the great toe is injured, and the soft tissue has damage to it. This is accompanied by pain, and it usually is onset by a hyper extension injury where the toe has forcibly moved upwards. Commonly, football is an injury historically with the type of turf it is played on, but this has become less common. Now, this injury is seen in baseball players running around the bases, some soccer injuries, and trauma in general.

The hallmark of a turf toe injury is pain on the bottom of the great toe and is caused by an acute injury. It is associated with swelling and there is sometimes bruising into this area and a general reluctance by the patient wanting to walk on it. This can often lead to a feeling as if you’re walking on the outside of the foot. When you can’t walk on your foot, generally an evaluation should be had, and Dr. Miller can see you and provide a good evaluation. When being seen for a turf toe injury, we will examine the foot in general to make sure there is nothing else going on. But the focus and concerns will be surrounding the bottom of the great toe. This is where the soft tissue could be injured or the sesamoid bones, which are accessory bones that work in conjunction with the soft tissue to provide stability and function to the toe. Think of this as the kneecap to your knee. The kneecap functions as a fulcrum to make the knee move better. It is attached to muscles and tendons which allow the knee to move which is similar to the toe with the accessory bones called sesamoids on the bottom of the toe. When this complex is injured, you have difficulty with pain and push off. People will also have instability where the big toe itself moves abnormally. This creates pain, but the increase in motion is not physiologically motion. This abnormal motion over time causes pain and results in wear and tear in the joint.

In most cases these injuries can be treated non surgically. They often take extensive protection and time. Some patients will start out in a boot and if the toe is stable overall where the soft tissue is injured partially or just a sprain of the tissue, this can be successful and appropriate shoe-ware and protection is provided. Often after the boot the patient will be transferred to an extension or carbon fiber plate insert for continued protection in a normal shoe as the patient starts to get back to normal activities. In mild cases, a couple weeks of protection may get the person back to playing sports. In more significant cases, several weeks can be the appropriate recovery period.

Surgical intervention is usually left for the complete tear or instability of the soft tissue where the turf toe is associated with a complete tear which is called a plantar plate. This is where the sesamoid is completely detached from the soft tissue that attaches to the bone of the great toe. Surgery involved repairing the soft tissue or even reconstructing it with the associated tissues around the toe.

Post operatively the patient is often non weight baring, initially walking on the heel after 2-3 weeks of protection. This is followed by walking in a boot and physical therapy to begin mobilizing the lower extremity. Usually, full impact is not recommended for 2-3 months following the injury.


If you believe you may be experiencing a turf toe injury or know someone he may, Dr. Miller is Beacon Orthopedics’ foot and ankle specialist and is available at several locations around the Cincinnati area. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for foot and ankle injuries.