Turf Toe


Turf toe is a sprain to the ligaments around the big toe metatarsophalangeal (MTP) joint. It is usually caused by the big toe being excessively bent upwards into hyper extension. The condition may also occur from stubbing the toe or by repeatedly pushing off during running or jumping. It is most commonly seen in football and rugby players.

De Quervains tenosynovitis

Symptoms of Turf Toe


If the injury occurs due to an acute forceful extension motion to the big toe, it will become suddenly painful and swell up at the base of the big toe. There will also be a limited range of movement in the big toe joint. Symptoms will gradually get worse over the next day and bruising around the toe may occur.

When turf toe is caused by repetitive forceful extension of the big toe, the pain, swelling, and stiffness will develop gradually and get worse with time.

Causes of Turf Toe

Turf toe commonly occurs during certain sports, such as rugby and football. This occurs when the front of the foot is planted on the ground with the heel lifted, and then the big toe is forcefully pushed into hyperextension.

It is most common when playing on artificial turf, hence the name – “turf toe”. This is because artificial turf is less flexible and shock absorbent than grass. Due to the harder ground, shoes are also more likely to get stuck – particularly if wearing studded football boots.

The injury also occurs more often when wearing flexible shoes. Softer and flexible shoes give the athlete more agility however doesn’t provide much support for the forefoot and therefore allows the big toe to bend too far back.



      The big toe is made of two joints. Turf toe occurs in the metatarsophalangeal (MTP) joint of the big toe, where the 1st metatarsal bone and the proximal phalanx of the big toe meet.

      The MTP joint is stabilized by a number of structures that holds the MTP joint in place and prevent dislocation. Turf toe is when these structures get injured or torn by hyperextending or jamming the toe.

      These structures include:

      • Plantar plate.
        A thick and robust ligament that runs under the MTP joint and attaches from the proximal phalanx to the metatarsal head. It prevents the big toe from hyperextending.
      • Collateral ligaments.
        These ligaments run along either side of the MTP joint and attach from the proximal phalanx to the metatarsal head. It prevents the big toe from going too far from side to side.
      • Flexor hallucis brevis tendon.
        This tendon attaches underneath the proximal phalanx and runs under the first metatarsal bone. This muscle flexes the big toe and helps during the push-off movement when walking.
      • Sesamoid bones.
        There are two small bones embedded into the flexor hallucis brevis tendon. These two sesamoid bones act like a pulley for the tendon to stabilize the first MTP joint. They also help absorb the force that transmits through the ball of the foot.

      How to diagnose


      At your physiotherapy appointment, the clinician will obtain a thorough history and examine your foot. The physiotherapist might perform an ultrasound scan within the clinic to assess the grade and severity of the injury. In certain circumstances, an  X-RAY might be requested to rule out a fracture.

      Physiotherapy Treatment


      Most mild-moderate cases will resolve with conservative treatment.

      Initially, treatment is focused on reducing pain and swelling of the big toe, before rehabilitating the big toe to its normal function.

      For mild cases which don’t involve any significant tearing of structures, the patient will be given a range of gentle mobility exercises, which can be started within a few days of the injury.

      Bracing, splinting and taping can be used to help tolerate weight-bearing activities.

      An appropriate graded rehabilitation plan is key for recovery, as progressing too quickly can re-aggravate the injured tissues.

      Severe injuries will require a period of immobilization – using a cast or removable walking boot, then a progressive rehabilitation program. In rare cases, surgical intervention may be indicated.

      Injection Therapy


      If symptoms have not improved with Physiotherapy and pain is still causing you to limit your activities then you may want to consider an ultrasound guided steroid injection.

      An ultrasound-guided steroid injection into the big toe joint is a powerful way to reduce pain and inflammation. If the Turf Toe injury occurs on a background of an arthritic joint then we can consider also adding Hyaluronic acid to the injection to help the joint surface lubrication. 

      If you are experiencing symptoms similar to those described above and want to find out what is causing your pain, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk