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Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes

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Abstract

Purpose of Review

First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries.

Recent Findings

Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability. Rehabilitation protocols following non-operative management consist of 3 phases lasting up to 10 weeks, whereas protocols following operative management consist of 4 phases lasting up 20 weeks. Athletes with low-grade injuries typically achieve their prior level of performance. However, among athletes with higher grade injuries, treated both non-operatively and operatively, about 70% are expected to maintain their level of performance.

Summary

The treatment protocol, return-to-play criteria, and overall performance outcomes for TT injuries depend on the severity and classification of the initial sprain. For grade I injuries, players may return to play once they experience minimal to no pain with normal weightbearing, traditionally after 3–5 days. For grade II injuries, or partial tears, players typically lose 2–4 weeks of play and may need additional support with taping when returning to play. For grade III injuries, or complete disruption of the plantar plate, athletes lose 4–6 weeks or more depending upon treatment strategy.

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Acknowledgements

The authors would like to thank and acknowledge Clifford Jeng, M.D. (Mercy Medical Center) and Paul Talusan, M.D. (University of Michigan), for generously contributing radiographic and intraoperative images.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA

    Arjun Gupta, Priya K. Singh, Amy L. Xu, Rachel S. Bronheim, Claire M. McDaniel & Amiethab A. Aiyer

  2. Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07103, USA

    Arjun Gupta

  3. Department of Orthopaedic Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA

    Priya K. Singh

  4. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Amy L. Xu

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Correspondence to Amiethab A. Aiyer.

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Arjun Gupta, Priya Singh, Amy Xu, Rachel Bronheim, and Claire McDanieal declare that they have no conflict of interest. Amiethab Aiyer has the following disclosures: American Orthopaedic Foot and Ankle Society (board or committee member); Bioventus (paid consultant); Delee and Drez Orthopaedic Sports Medicine — Elsevier (publishing royalties, financial, or material support); Journal of Bone and Joint Surgery — British (editorial or governing board); KCI (paid consultant); Miller’s Review of Orthopaedics — Elsevier (publishing royalties, financial, or material support); Novastep (paid consultant); Smith and Nephew (paid consultant); Vilex (paid consultant)

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Gupta, A., Singh, P.K., Xu, A.L. et al. Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Curr Rev Musculoskelet Med 16, 563–574 (2023). https://doi.org/10.1007/s12178-023-09870-y

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