Turf toe: Is not a common running injury.  It is usually associated with football or soccer. It is a sprain of the ligaments of your big toe, similar to but different than bunions.  (if you read both sections, the treatments are very similar.)  But runners can get turf toe from trail running or downhill running.

History: This is unusual in running.  It is a traumatic injury.  You get it when you jam your toe into the ground.  Usually, when a runner gets turf toe, it is from a trip and fall.

Self-Exam:  Here are some things you can look for in yourself. 

1)      The joint where your big toe joins the foot is very tender to touch. PH 

2)      It hurts to do a single leg heel raise on your toe. VID . 

3)      You have pain on the push-off phase of gait.  VID .

Treatment:

1)      Manage the pain:

a.      NSAIDS will help. 

a.      P.R.I.C.E.

                                                              i.      Protect yourself from further injury.  Kinesiology tape, ACE wrap, neoprene sleeve, etc.

1.      NOT an immobilizer.  You need to keep your foot moving without pain.

2.      At this stage you do not need anything fancy, just to keep your toe from moving stupid and causing more injury.

1.      Some sports medicine practitioners recommend a stiff orthotic to place in your shoe

a.      Personally, I’m not too crazy about this because it helps your sore toe, but a stiff orthotic changes your running form and may make something else hurt.

                                                            ii.      Rest your toe.  If it hurts, STOP.

                                                          iii.      Ice your toe.  About 20 minutes and no more than 3-4 times per day.  If you do not have an ice pack, a two-pound bag of frozen peas or corn will do.

3.      Keep a of towel between your skin and the bag.

4.      I really prefer the frozen peas or corn to a chemical ice bag you break open.  Some of those get really cold and others don’t get very cold.  You are not sure how cold the pack will be.  Ice is 32o.  You know what you get.

                                                           iv.      Compression will help reduce the swelling.  Not a tourniquet, just moderate compression to reduce the swelling

                                                             v.      Elevate your foot with your ankle above your knee and your knee above your hip.

b.      Kinesiology taping usually does not help.  It does not provide enough support

c.       Buddy taping to second toe helps sometimes.

d.      Continue running but avoid aggressive speed work and hill repeats, especially downhill running.

2)      Restore full motion:

a.      This is a case of, “Wait a little bit”.  Turf toe is a ligament sprain.  You want the sprain to heal before you begin stretching it.

b.      Stretches to your plantar fascia and heel cord will decrease the stress on your toe.

                                                              i.      Sequential short-term running will address these muscles.  VID

c.       Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

3)      Begin non-weightbearing exercises to restore strength without all the pressure on the joints

a.      Exercises to strengthen the foot muscles.

                                                              i.      Towel rolls, marbles, short foot, alphabets, toe stretching.   VID

                                                            ii.      Progress to tubing exercises for the same muscle.  VID

b.      You will not be at this level very long; we just need to increase your strength while minimizing stress on your foot.

4)      Begin body weight exercises with emphasis on control versus strength and power.

a.      Apply the kinesiology tape to your big toe before you start your weight-bearing exercises.

b.      These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.

c.       Big toe (MTP) stretches, heel raises, static and then dynamic lunges.  LIN

d.      One important activity which should be included with all leg injuries.  BALANCE EXERCISES!  It is amazing how quickly our balance deteriorates after any injury to our lower extremities. 

e.      Click here for video to know if you are ready to progress to more aggressive exercises.

5)      Correct running mechanics. 

a.      Gradually return to your previous running.  Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move.  If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run.  Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.

b.      As soon as you can run without pain and without a limp you can return to your normal running routine.

6)      Return to running speedwork and hills.  After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

7)      My favorite step, get back to full running!  Have fun.  Eventually you will bust something else and be back to the website to fix that. 

8)      If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.