Turf the "Turf Toe" Injury

Often around this time of the year, football injuries become more prevelant in our practice with high school and junior leagues. The great toe will get hyper-extended for a brief moment, and this leads to pain and inability to return to sport. Sometimes this injury can lead to chronic instability of the toe joint which may lead to arthritis and eventual need for surgery if not treated properly with initial presentation. This injury is typically treated incorrectly with coritsone injections, and this may actually lead to further damage to the joint capsule and even the ligament between the sesamoid bones. Treatment for this condition starts with proper evaluation, detailed history and physical examination, and sometimes with foot blockade of local anesthetic or even arthrogram, we can diagnose and give a prognosis to return to the field in 1 visit. This treatment may consist of casting, immobilization, PRP injections, or even surgery for progressively more unstable joints or specific findings from MRI examination. Ultimately, athletes can expect a minimum of 2 weeks off, followed by gentle passive range of motion exercises, and finally we may allow return to the field for practice and eventual playing time. Most athletes will not return to the field if they are unable to dorsiflex the great toe joint at least 50 degrees without pain. If a patient has progressive deviation or valgus deformity becomes evident, surgery is most likely indicated. If the pain improves after proper immobilization and therapy driven rehabilitation, many will not require surgery.  Ultimately it is decided based on timely diagnosis, treatment, and therapy driven rehabilitation. Notable players who have had Turf Toe injury include Deion Sanders and Ray Lewis. Sometimes this injury will end the professional player's career.