Foot & Ankle

How to Minimize Turf Toe Recovery Time

By October 21, 2019 No Comments

Athletes who play contact sports, especially on harder surfaces such as turf, are prone to many injuries as the body is constantly under some form of stress during activity. A common injury for this type of athlete is called turf toe. Turf toe is a result of the toe joint being placed under stress, and often translates into issues with the joints and ligaments of the big toe. This article will briefly discuss the anatomy of the big toe, symptoms of turf toe to look out for, what could be causing it, how the condition is diagnosed and treated, and a new form of therapy which may decrease recovery time called regenerative medicine.

Anatomy of the Toe

The toe consists of two joints, the metatarsophalangeal (MTP) joint at the base of the toe and the interphalangeal (IP) joint in the toe. The MTP connects foot bones to the proximal phalanx, the first bone of the big toe. The IP joint connects the proximal phalanx to the distal phalanx, the bone at the end of the toe.

Ligaments are a tough form of soft tissue that serve the function of connecting bone to bone, or holding joints together. Turf toe is an umbrella term for general dysfunction of the ligaments or joints in the big toe. Ligaments can become strained or snap. This can cause the joint structure to change in a way that causes pain.

Symptoms of Turf Toe

The main symptoms of turf toe to look out for are:

  • Pain in the toe
  • Swelling around the toe joint
  • A “popping” feeling during motion
  • Limited mobility in the toe joint

Symptoms can appear with low intensity and worsen over time. If turf toe is a result of an injury, symptoms may come on quickly and with high intensity. Once the symptoms begin to interfere with daily activities, or take a player off the field, a consultation with a doctor may be necessary.

Who is at Risk and Causes of Turf Toe

Turf toe gets its name because the population who is at the greatest risk of developing it are athletes of contact sports, which generally involve artificial turf. The risk is not limited to turf sports, however. Any athlete playing on a hard surface could be at risk. Some of the sports which put athletes at a greater risk are football, lacrosse, and soccer. Other athletes are also at risk, such as dancers and runners. Some non-athletes may also be at risk, as it is an injury of the toe it can develop in anyone.

Many cases of turf toe are also linked to athletes who wear shoes that provide little support. Shoes that are capable of bending with the foot can also allow the foot to bend in such a way that may snap the ligaments inside.

These types of athletes are at greater risk because one of the main causes of this condition is repetitive stress to the toe. The condition can also be caused by an injury which causes the ligaments to snap.

Diagnosing Turf Toe

Once an injury has occurred, or once symptoms become difficult to manage or interfere with daily life, it is recommended to meet with a doctor. Once the evaluation begins, doctors will ask questions about activity level, family history and personal history, history of foot injury or problems, and shoe preference. The goal of these questions is to come to a conclusion of what may have happened that is causing pain. Doctors will also examine the foot, looking for swelling and testing the toe’s ability to bend.

Some doctors can come to a diagnosis with evaluation alone, but many will order certain imaging tests in order to ensure that the diagnosis is correct. These may include:

  • X-Ray: this imaging test provides an image of the bone structure in the foot, so it may be used to rule out any other structural issues which may be causing pain.
  • MRI: Magnetic Resonance Imaging, or MRI, is used to gather an image of the soft tissue in the foot. This will allow doctors to see if ligaments are stressed or snapped, leading to a proper diagnosis.
  • CT Scan: this form of imaging can create an image of some soft tissue and bone, which may allow doctors to make a diagnosis of turf toe depending on the results.

In the doctor’s office, it is important to be completely honest about where pain is located and the severity of it. This will give doctors a more clear idea of what is causing pain.

Once doctors have made a diagnosis, they will begin to devise a treatment plan. Each treatment plan is specific to the patient based on their needs. These needs include activity level, profession, severity of the injury and pain, and many more.

Treatment of Turf Toe

Many doctors will recommend rest to begin the treatment process. A common treatment of sports injuries is called the RICE method. This stands for Rest, Ice, Compression, and Elevation. All of these will help the injury to heal more quickly. This method may be coupled with over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen or Naproxen. If employing the RICE method does not do enough to relieve pain, then doctors may recommend more intensive treatment. This could include:

  • Physical Therapy: the goals of physical therapy are to generally improve circulation, strengthen muscles, and regain support in the injured area. Certain exercises can be done which will improve an individual’s chances for a full recovery.
  • Cast: some techniques that are used to immobilize the joint such as a cast or boot may be used to allow the big toe to recover. Boots may be used only during certain activities, such as walking or standing, or it may be recommended that the boot be on all the time.
  • Relieving Pressure: along with resting the injured area as much as possible, some doctors may suggest that the foot be unused. This often comes in the form of crutches or other walking aids that would allow the foot to be under significantly less pressure.
  • Supportive Shoes: many doctors will also recommend that patients wear shoes that do not allow the toe to bend, especially when the patient returns to playing sports or other athletic activities.
  • Taping Toes: some doctors will recommend that the big toe be taped to other toes so that some of the pressure is taken off of the big toe joint.
  • Surgery: in extreme cases, surgery may be necessary. It is not often necessary to treat turf toe, but if there is more than one underlying issues it may be beneficial to patients. Different surgical techniques may be employed and will vary based on the severity of the injury. Surgery is almost always elective, meaning it is the patient’s decision to do it. Surgery comes with a set of risks which may vary slightly depending on the surgical procedure. The most common risks are complications with anesthesia, infection, and stroke. It is important to maintain a line of communication with surgeons in order to be as informed as possible. The main goals of surgery are typically to repair damaged tissue, or remove/replace aspects of the joint which may be causing pain.

Each treatment will be recommended based on the patient’s needs and the severity of their injury.

Some individuals who are diagnosed with turf toe can get back to their normal lives after a matter of days. In more extreme cases, it may take weeks or even months to undergo the proper treatment. In the case of assistive devices such as crutches, or when wearing a boot, it may be necessary to continue for months. In the more extreme case of surgery, recovery may take up to a year.

There is an alternative form of treatment called regenerative medicine which may speed up the recovery process.

Regenerative Medicine and How it Can Decrease Recovery Time

The field of regenerative medicine and therapies is quickly gaining traction in the medical field because of the high success rate. CELLAXYS offers two of these types of treatment:

  • Stem Cell Therapy: this form of therapy begins with extracting stem cells from a patient’s own body. They are typically taken from fat tissue, blood cells, or bone marrow. The stem cells are then processed so that they are more concentrated. The concentrated stem cell solution is then injected into an injury. Stem cells contain healing properties that the body already uses in its natural healing processes. These cells are also able to call to other healing cells and concentrate them in an injured area.
  • Platelet-Rich Plasma (PRP) Therapy: this form of therapy begins with a simple blood draw. The blood sample is then placed in a centrifuge, where it is spun around to separate the platelets from other aspects of the blood. The concentrated platelets are then injected into an injury site. Platelets contain growth factors and proteins which the body uses in its natural healing processes. PRP therapy seeks to increase the concentration of healing properties in an area, which can then in turn allow recovery to happen more quickly.

Both forms of therapy are outpatient procedures which take no longer than two hours. Reported side effects include pain around the injection site, which typically goes away in a day or two. The risk of rejection is very low, as it is using a patient’s own cells. There is a minimal risk of infection, as with any medical procedure.

Doctors use imaging techniques such as ultrasound to ensure that the needle is inserted into the exact correct spot. Doing so allows for the most amount of healing properties to be delivered to the correct area.

These types of treatments have been particularly effective in treating injuries to the soft tissue. Turf toe is an injury to soft tissue, whether it is the ligaments which are under stress or the padding between the bones in the toe joint. Both injury locations would be likely to respond well to regenerative medicine.

These types of treatment can be coupled with other treatments such as physical therapy. If surgery becomes necessary, regenerative medicine could be used in the recovery process to potentially speed up the recovery time and help the body heal.

Increasing the amount of the body’s own healing factors could mean that the recovery time for this injury becomes shorter, as it is healing more quickly. This may be a good option for athletes who are looking to get back on the field sooner rather than later.

Conclusion

Turf toe is an injury that occurs in the ligaments of the toe and the toe joint. It is most common in athletes who play contact sports on hard surfaces with poor shoe support. It can, however, occur to anyone at any time. Diagnostic methods can help doctors pinpoint the underlying cause of pain, as well as identify other potential issues that may be contributing to pain. Treatment of turf toe begins with minimally invasive techniques such as the RICE method and taping toes, but can escalate to more invasive techniques such as physical therapy or surgery. In the recovery process, it is important for patients to consider all of the options available. Regenerative medicine could be a solution to having a shorter recovery time, meaning that athletes and non-athletes alike can return to doing what they love more quickly.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni