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Pediatric - Turf Toe

Turf Toe is a fairly common injury that occurs in physically active children and adolescents involved in contact athletic sports. It is defined as a hyperextension injury (sprain) of the 1st metatarsophalangeal joint (main joint) in the big toe. Turf toe injuries involve the big toe joint, as well as the 2 small bones, called the sesamoids, that are found underneath the big toe. A turf toe injury occurs when the big toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground. Such injuries are common in football players, soccer players, baseball, and softball players. The term “turf toe” is derived from the artificial turf that has become more common on the playing field, since the artificial turf is a harder surface than grass and does not have much “give” when force is placed on it.  

Turf toe can occur during any physical activity or sport when the forefoot (end of the foot) is fixed on the ground, the heel is raised, and a force pushes the big toe into hyperextension. Athletic shoes, such as running shoes and cleats, are designed for artificial surfaces, such as turf grass, making them soft and more flexible, providing athletics with more agility, but much less stability in the forefoot, making turf toe more prevalent. 

After sustaining a tuft toe injury, the athlete will have trouble walking appropriately and/or even participating in sports. The big toe may appear red, swollen, tender to touch, and moving the big toe may trigger pain and discomfort. Initially, it is best to immobilize the big toe and not to participate in any sports or physical activity, and make an appointment with a Foot and Ankle Specialist at Valley Foot and Ankle Specialists.  

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Examination 

During your initial examination, your foot and ankle specialist will talk to you about the symptoms and the risk factors associated with turf toe, and ask you to describe how you initially injured your toe. The doctor will attempt to move the big toe joint up and down slightly and examine for further tendon and/or bone injury, as well as examine for bruising and swelling. The doctor may also perform the same exercises on the other foot in order to compare the extent of injury. The doctor will take X-rays of the injured foot to evaluate for any fractures and rule out any potential harm to the growth plate in young pediatric patients. Although placing the injured toe through range of motion exercises may be painful, if needed, your doctor may inject numbing medicine into the painful area, although this is a rare occurrence.  

Sometimes advanced imaging may be indicated in order to help confirm the diagnosis.  

The doctor may order a magnetic resonance image (MRI) scan in order to better evaluate the soft tissue, ligaments, and cartilage of the big toe joint and determine whether surgical intervention or conservative therapy is indicated. Sometimes small bones may be present in the big toe joint that may not be visualized on Xray and/or fluid in the joint that may cause prolonged swelling. An MRI scan may be useful in more advanced injured or when abnormalities are noted on the initial X-ray, or when the injury has not improved with conservative treatment.  

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Treatment 

Initial treatment after the injury includes the R.I.C.E method: Rest, Ice, Compression, and Elevation. The use of non-steroidal anti-inflammatories (NSAIDS) are indicated to control swelling and pain/discomfort, and tapping the big toe to the 2nd toe may help with immobilization and prevention of further injury.  

Conservative (Non-Surgical) Treatment  

After a thorough evaluation, the doctor may place the patient into a walking boot to immobilize the injured foot and allow for protected ambulation. The patient may be immobilized in the walking boot for 2-6 weeks with routine examinations, in order to transition the patient from the walking boot and into a supportive sneaker and begin Physical Therapy for appropriate return to sports. 

Surgical Treatment 

Surgical treatment for turf toe injuries is routinely indicated for severe (Grade III) injuries that have failed conservative treatment and/or noted with severe dislocation or subluxation of the big toe joint. Instability of the joint or the presence of bony fragments in the joint are indications for surgical treatment in order to prevent further complication.  

The goal of treatment is to have the patient return to physical activity and/or sports in a timely manner, following appropriate healing and conditions order to prevent further injuries and long-term complications.  

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