“Turf toe” is actually the common name for the sprained first metatarsophalangeal joint. The first metatarsophalangeal joint is the second joint at the far end of the big toe, that is, the joint where the big toe meets the sole of the foot. The sprain of the first metatarsophalangeal joint is commonly known as “turf toe”, “turf toe” or “artificial turf toe”. It refers to the excessive dorsiflexion of the first metatarsophalangeal joint leading to damage to the soft tissue of the joint capsule complex (including related ligaments, tendons, and joints, damage to the sac, plantar plate, etc.).

Essentially, the turf toe refers to a sprain at the base of the big toe caused by the unusual stress on the ligaments that control the range of motion of the toe. When the toes are beyond the normal range of motion, such as bending the toes in an uncomfortable direction, the ligaments will stretch and usually tear slightly. Patients with turf toes often experience changes in mobility, and it is possible to form turf toes in many different environments.

The first metatarsophalangeal joint sprain is called “turf toe” because this kind of sports injury mostly occurs on turfed sports fields such as football fields and rugby fields. In this type of sport, the first metatarsophalangeal joint often suffers excessive dorsiflexion and injury occurs under the drive of body inertia and external force (the dorsiflexion activity of the first metatarsophalangeal joint usually does not exceed 100 degrees). Especially in recent years, such sports have become more popular in China, and artificial turf accounts for a large proportion (the hardness under the artificial turf is higher, which is more likely to cause toe sprains), which has greatly increased the incidence of “turf toes”.

The main symptoms of the turf toe are local pain, swelling, ecchymosis, and muscle tension near the area where the thumb and the sole of the foot are connected, and a painful gait when walking (unconsciously avoiding the weight of the big toe). Imaging examinations such as MRI can be used to determine the soft tissue damage near the joint capsule, and to exclude other types of lesions and injuries such as the sesamoid bone, articular surface, metatarsal bone, tendon sheath, etc.

If it is just a sprain of the soft tissue of the first metatarsophalangeal joint (turf toe), rest, ice, compression bandaging, and elevating the affected limb can be used to relieve pain and swelling during the acute symptom period. When the acute symptoms are controlled, they can gradually return to daily activities and sports activities with the assistance of protective devices (such as walking boots, hard-soled shoes, and herringbone bandages). However, if the symptoms are caused by other diseases, different treatment options should be considered according to the situation. In this context, turf toe should be distinguished from the following diseases with similar symptoms.

1. Fractures and dislocations of the hallux. It can be checked by imaging evidence (for example: finding significant evidence through X-ray, bone scan, CT, MRI, etc.).
2. Hallux stiffness, metatarsophalangeal arthritis. It is mostly related to chronic diseases such as bone spurs, osteophytes, and tissue fibrosis, and is generally not an acute disease; it can be checked by imaging evidence.
3. Injury of the sesamoid bone. The tenderness points are more concentrated on the sesamoid bone, and the range is smaller. Can be checked by imaging evidence.
4. Fatigue fracture of the sesamoid bone. Tenderness points are more concentrated on the sesamoid bone, and the scope is smaller; chronic diseases; can be checked by imaging evidence.
5. Two sesamoid bones. The sesamoid bone is cracked due to congenital non-fusion, and imaging examination shows a low-density line (non-fracture line) in the middle of the sesamoid bone; there is no tenderness; the probability of bilateral simultaneous occurrence is greater.
6. Semen osteoarthritis. Tenderness points are more concentrated on the sesamoid bone, and the range is smaller; the pain is aggravated during activity; it can be checked by imaging evidence.
7. Avascular necrosis of the sesamoid bone. Tenderness points are more concentrated on the sesamoid bone, and the scope is smaller; imaging examination shows nearby loose bodies.
8. Tenosynovitis of flexor tendon stenosis. Visible “trigger phenomenon” (bounce or frustration when flexing and extending the hallux); pain when the flexor hallux (foot) longus tendon moves, and nuclear magnetic examination shows tenosynovitis.
9. Gout. Tenderness and erythema of the metatarsophalangeal joints can be seen. There is no acute injury experience before the pain, high uric acid, and urate crystals can be seen from joint puncture.

Ice packs may help relieve pain associated with the toes. Recognizing turf toes is not difficult, because this condition exhibits a variety of physical characteristics. Almost all of them are metatarsophalangeal toes. A common symptom is bruising around the soles of the feet and on the top of the big toe. In more severe cases, the toes feel extremely tactile. Soft, swollen toes and soles. To treat lawn toes, the feet should be elevated as much as possible to reduce the pressure on the toes. Due to the characteristics of turf toes, people with this disease usually experience changes in mobility. It is usually painful to put any weight on the affected foot, and it is particularly uncomfortable to put any pressure on the sole of the foot. A torn ligament is very difficult to push away with the big toe and is accompanied by severe pain. Due to swelling, the big toe has lost most of its normal range of motion.

If there is severe swelling of the big toe, consult a doctor immediately. Common treatments for turf toes include minimizing swelling and securing the big toe. For this reason, it is recommended to alternate hot and cold therapy during the first 24 hours, followed by cold compresses. Over-the-counter medications can help reduce the amount of local inflammation. It can also help reduce pain and help the swelling to fade away. The feet should be elevated as much as possible to reduce the pressure on the turf toes and allow the torn ligament to begin the healing process. Football players may experience severe swelling of turf toes and it is best to see a doctor immediately. The doctor can examine the toe to determine if the injury requires a cast on the area, or if a prescription anti-inflammatory medication is helpful. In most cases, however, it can be treated at home without the need to see a doctor. A simple course of treatment is to apply cold to the swollen area, take medicine to reduce inflammation, and lift the foot for a long time, which can make the turf toe within a few days began to fade.

If the pain persists after turf toe treatment, use a splint to fix the area.