Turf Toe: 40 Years Later and Still a Problem

“Turf toe,” originally described in literature by Bowers and Martin in 1976, is an injury to the capsuloligamentous complex of the first metatarsophalangeal joint. This injury is common in football players. Up to 45% of National Football League (NFL) players have suffered from turf toe during their professional career. Turf toe injuries have been attributed to playing on hard, artificial surfaces with soft, flexible cleats; 83% of the turf toe injuries occurred on artificial turf. For most turf toe injuries, nonoperative treatment is the preferred approach, even in some cases with associated fracture of the sesamoids. Operative intervention should be considered after nonoperative management has failed or in cases of clear instability or sesamoid retraction. Good functional outcomes with high rates of return to play can be expected with appropriate management. Despite this, persistent symptoms of stiffness and great toe pain are not uncommon following initial injury, surgery or both. Due to limited availability of high-level evidence regarding the outcomes of turf toe injuries, particularly for surgical management of high-level athletes, this article will combine what is available with level V evidence based on the senior author's experience over 34 years and his discussions with other experts in the unique subspecialty of foot and ankle sports medicine.