Stage 1 turf toe (hallux limitus) describes an injury to the surface cartilage of
radiographic anatomy of the foot the great toe joint. One of the simple tricks to ‘off-load’ stage 1 injuries is to use a pad to plantarflex the the bone just behind the great toe called the 1st metatarsal. The range of motion of the great toe can be significantly improved by plantarflexing the 1st metatarsal. The best way to accomplish this is with the use of a dancer’s pad. Using a dancer’s pad can be a little tricky at first, but once placed in the correct position, the 1st metatarsal will plantarflex and improve the range of motion of the joint. Better range of motion means less pain. The following Turf Toe straps work well also if you do not have the time or leisure to wear the dancer pads.
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As we progress into stage 2 turf toe, the use of a dancer’s pad becomes less useful. The reason that a dancer’s pad may no longer work is due to the fact that the joint now is starting to undergo physical change. Classic findings of stage 2 (see link above to hallux limitus) include dorsal beaking of the joint and early chondromalacia (degenerative change of the cartilage). Early stage 2 may benefit from a dancer’s pad but as we move to late stage 2 and stage 3, dancer’s pads will become ineffective.
Stage 3 turf toe is classified as complete tear of the capsuloligamentous complex of the 1st MTP joint, tearing of the plantar plate from its origin on the metatarsal head/neck, and dorsal impaction of the proximal phalanx into the metatarsal head. Associated injuries include articular cartilage or subchondral bone bruise, sesamoid fracture, diastasis of the sesamoids, and medial or lateral ligament injury.
Causes Of Turf Toe
Turf toe injuries account for more missed practice and training than ankle sprains, despite occurring less often.
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| Location of Turf Toe in X-Ray |
Turf toe can be both acutely and chronically disabling if not treated appropriately. In fact, approximately 50% of all patients with hallux limitus (turf toe) have persistent symptoms which include hallux rigidus (severe degenerative joint disease with loss of range of motion of the 1st MPJ), hallux valgus (bunion deformity), chronic capsulitis and/or extensor tendinitis.
Turf toe caused by a direct injury to the joint may or may not obvious initially. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the training progresses.
Turf toe pain will subside with rest only to recur with increased activity
It’s not unusual to see symptoms of turf toe resolve in the off-season only to recur with renewed exercise. This condition is not just associated with sports or training injuries to the 1st MPJ. Some sedentary patients have a biomechanical abnormality which results in jamming of the 1st MPJ with every step. After several years, degenerative changes occur causing a hallux limitus or rigidus.
