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Turf toe: A complete physical therapy guide

Do you know what is turf toe? Have you ever hyperextended your big toe while playing sports like football, etc. what are the signs and symptoms, and what is the physical therapy treatment for turf toe?

The turf toe is also known as a metatarsophalangeal joint sprain.

You will get the answer to each one of these in this article so keep reading.

What is turf toe?

It is the injury (sprain) to the ligaments and capsule around the big toe (metatarsophalangeal joint). Hyperextension and hyperflexion lead to the injury of the big toe.

You may experience limited joint mobility at the metatarsophalangeal joint of the big toe.

To understand turf toe, let’s take an example of a patient. So in this case, a 20-year-old football player hyperextended the great toe on synthetic turf grass. He thinks that his cleat may have gotten stuck in the turf while being tackled. The player has a painful and swollen metatarsophalangeal joint of the great toe.

He cannot walk or run without pain.

A patient tells us that his toe starts to hurt the most when he tries to push off with a great toe.

There are three grades of severity

  • Grade 1 sprain:- in this case, there is a minor stretch to the soft tissues and suffering from little pain, swelling, or disability.
  • In this case, Grade 2 sprain:- there is a partial tear of the capsuloligamentous structure with moderate pain, swelling, and disability.
  • Grade 3 sprain:- in this case, there is a complete tear of the plantar plate with severe swelling, pain, and inability to bear weight normally.

turf toe symptoms

  • There is pain at the base of the first toe.
  • It starts suddenly as a result of injury.
  • In this case, there is decreased extension or flexion of the big toe.
  • A patient may experience limited motion of the metatarsophalangeal joint due to pain.
  • Joint redness

Possible contributing causes

  • Trauma
  • Abnormal bone structure

Differential diagnosis

Test for diagnosis

  • Flexor hallicus longus strength
  • First metatarsal mobility
  • Gait analysis

Turf toe treatment


  • Anti-inflammatory
  • Corticosteroid injection

Medical procedure

  • Surgery

Physical therapy treatment


In this case, you need to take proper rest and weight off your feet will allow for reduction of inflammation.


It will stabilize the big toe and limit extension (range of motion).


We can use orthotics with firm extension to the toes to limit the toe range of motion.

Once the patient has a full pain-free range of motion, we can remove the orthotic.

Donut pad

It is used to offload the pressure on sesamoids.


A rigid footplate is used to limit toe extension.


When we need to treat the swelling, we use ice

When we are focusing on pain, we follow this sequential process

  • Ice or contrast bath
  • Massage
  • Joint mobilization
  • Electric stimulation
  • Iontophoresis
  • Ultrasound
  • Infrared

When we are focusing on weakness or joint instability

Strengthening exercises

Toe curls, flexor intrinsics (towel crunches, marble pick-ups)

Flexor hallicus longus isotonics

turf toe

Great toe abduction

turf toe

Active walking

active walking

Standing arch raises

Calf raises to point


When we are focusing on lack of flexibility


  • Soleus stretching in case of Achilles contracture

Joint mobilization

  • MPJ dorsal/plantar/rotational/medial/lateral glides
  • Sesamoid glides superior/inferior
  • Posterior talus glides
  • Subtalar joint inversion/eversion

Functional goals

  • A patient will be able to recognize and maintain a subtalar neutral position for more than 2 minutes.
  • He will be able to ambulate pain-free for more than 45 minutes.
  • Achieve 15 degrees of talocrural dorsiflexion during the stance phase of gait with a normal pattern pain-free.
  • He will achieve 65 degrees of great toe extension during the push-off phase of gait with a normal pattern pain-free.

Prognosis (expectation after treatment)

  • A patient can expect a reduction in pain with conservative therapeutic intervention.
  • Grade 1 sprain, return as discomfort allows.
  • 3 to 14 days rest in Grade 2 sprain.
  • Grade 3 sprain, 2 to 6 weeks.
  • 50% of athletes will have persistent symptoms even after 5 years.


The turf toe is an injury (sprain) to the big toe, that mainly affects the metatarsophalangeal joint of the big toe.

We can go for the surgery in case of high severity but conservation intervention is always the best approach for its treatment.

In this article, we illustrated everything about the physical therapy intervention for turf toe.

Please give it a good read.


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