09 Dec Turf Toe Rehab Exercises
Turf toe injuries many times are left improperly managed and can lead to chronic pain, reduced push-off strength, and eventually joint deformity if left untreated. Turf toe describes an injury to the bottom surface of the big toe joint, known as the plantar metatarsophalangeal-sesamoid complex. Turf toe injuries occur when the joint of the big toe gets forced into hyperextension. This typically happens to football players when someone falls on their foot forcing the heel to drive forward over a planted big toe. This motion typically injuries the joint capsule and ligaments on the bottom side of the foot, leaving it painful. While most common in footballers, there is also a high incidence of turf toe injuries in rugby and soccer plays as well. This article will cover a rehab guideline for getting back on the field after an old turf toe injury, in addition, we’ve included a FREE turf toe rehab workout!
Early Stage Turf Toe Exercises
In the immediate stage after a turf toe injury, you’ll want to follow the P.O.L.I.C.E. protocol of protection, optimal loading, ice, cryotherapy, and elevation to keep the main levels manageable. Because the injury involves the big toe going into hyperextension, or pointing upwards, you will want to limit this motion early on. In this stage, excessive big toe hypertension can overstress the tissues on the bottom side of the foot that is injured, potentially the plantar capsule, flexor hallucis longus, and brevis, abductor hallicus, and medial/lateral sesamoids). The turf toe exercises in this phase are typically targeted towards gentle toe and ankle range of motion exercises and light strengthening exercises.
Sample PrehabX Video
HOW: Place a towel on the ground and put your foot onto it. With your foot flat on the ground, curl your toes and try to scrunch the towel closer to you. The goal of the exercise is to move the towel towards you completely!
FEEL: You should feel all the muscles in the bottom of your foot and toes working while you try to move the towel.
COMPENSATION: Keep your heel on the ground. Just move the towel by curling your toes.
Short Foot Doming
Sample PrehabX Video
HOW: Get set-up seated if you’re performing this for the first time, the goal is to progress to standing. While keeping your foot, heel, and toes flat on the ground as best as you can, think about pulling your big toe back towards your heel without actually bending your toes. Hold this position for a moment, then return to starting position When performed correctly, your arch will raise in height and your foot will shorten in length to form a dome shape.
FEEL: You should feel your foot and arch muscles working with this exercise, you should feel your arch tighten up. You may also feel muscles in your calf working as well.
COMPENSATION: Do not extend or flex (bend) your toes, do not lift your foot off the ground, do not move your foot side-to-side
Big Toe Abduction
Big Toe Lifts
In this phase, pushing off at the end of your stride will most likely hurt and you’ll want to take shorter steps. Pushing off your toes going up stairs may hurt as well. This is all normal! Limit how much you are pushing off initially; however, when the pain becomes less (not totally gone, mind you!) you should start trying to walk with as normal of a stride as possible. Going up and downstairs. And trying to be as mobile and active as possible while not overstressing the tissues. If playing sports, taping your big toe into flexion (toe pointed up), wearing firming shoes, or even using a hard turf toe plate insert may all help you continue to be out on the field while still recovering from a turf toe injury.
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Late Stage Turf Toe Rehab Exercises
As time goes on and your big toe starts to heal, we’ll actually want to begin loading the big toe in the exact same direction that it was injured. Our bodies are amazing at responding to stresses and subsequently getting stronger to handle them. Much like our muscles get bigger and stronger when we work out, our ligaments, capsules, and joints also get stronger when we “work them out” slowly and over time. That being said, it’s very important to monitor how much stress is applied to these tissues, as they are still healing!
A good rule of thumb to follow is that any additional discomfort while doing an exercise should not increase your baseline level of pain by more than 2 points, on a 10-point scale. Additionally, your pain should return to baseline levels within 24 hours.
Late-stage turf toe exercises all involve some degree of big toe extension. The key is slowly increasing either how much extension (how far the toe goes back) or how much load is applied with the big toe in extension (how much weight you put on it).
Turf Toe Rehab Exercises for Mobility
The first step is getting back full and pain-free big toe extension under load. While there are many ways to work on this, one of my favorites is this stretch below.
1st MTP Standing Stretch
Sample PrehabX Video
HOW: In a standing position with all your weight on your unaffected side, gentle place your foot with turf toe on the ground with the big toe pointed forward. Try your best to stretch the big toe and drive your heel backward. This stretch may not be comfortable. It is up to you to determine how much weight to put on your back foot – only put as much as you can handle. Go gentle!
FEEL: You should feel a deep stretch in your big toe itself, and potentially under the big toe/arch as well.
COMPENSATION: None. Only put as much weight as you can handle. Turf toe will be sensitive, go slow!
Once you have gained some big toe extension back and are comfortable walking on your tiptoes, calf raises should be a mainstay of your turf toe rehab program. Not only do they strengthening the injured tissues on the bottom of the foot, but they also strengthen the calf and the flexor hallicus longus.
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Turf Toe Rehab Exercises for Strength
Single-Leg Calf Raises Off Step
Sample PrehabX Video
HOW: Place a step in front of a wall or an object to use for balance. Using only one leg, step onto the box with the balls of your feet on the edge of the box, and let your heel hang off the box. While keeping your glutes and quads tight to keep your knee straight, lift your heel up in a slow and controlled manner, then slowly lower your heel back down to the ground. Repeat
FEEL: You should feel your calf getting a workout, but also your glutes and quads working as well to help keep your leg straight.
COMPENSATION: Do not let your knee bend as that is a different exercise. Make sure you go through your full range of motion at your ankle. This is not a balance exercise, so hold onto something to help with balance as the goal of this exercise is to strengthen your calf!
This calf raise variation is advanced. Start out using both feet on level ground, going as high as you are comfortable with. As you get stronger, you can progress to one foot and then do it off an elevated surface.
Sample PrehabX Video
HOW: Start in a half-kneeling position. The goal of this exercise is to work the kneeling leg. Keep your toes pointing into the ground. Keeping as much weight as you can on your back leg, drive your toes into the ground and try and lift your back knee about a ½ inch off the ground. Hold for the prescribed amount of time.
FEEL: You should feel the quadriceps muscle of your down knee holding your body up as well as a big stretch in your big toe.
COMPENSATION: Do not lean forward and shift the weight to your front leg. Try to use your back leg as much as possible to achieve the lift-off.
Turf Toe Rehab Exercises For Explosiveness
After spending a few weeks working on increasing your big toe strength and the ability for those injured tissues to withstand heavier loads, the next and final step in your turf toe rehab is to work on explosive push-off power. This is the hardest and often times the most fearful part of the rehab journey, as this is typically what has hurt the most in the past. As long as you have built up enough of a good strength base in the previous groupings of exercises, you should be able to slowly progress through these explosive exercises without problems!
Sample PrehabX Video
HOW: Keeping your hands on the wall for balance, hop on both legs. Don’t allow your knee to collapse in, most of the motion should be coming from your ankles. Think of yourself as a rubber band or a spring loaded coil. Be bouncy!
FEEL: You will feel the calf muscles working with this exercise.
COMPENSATION: Do not let your ankle “roll out”. You should feel even pressure between the inside and outside of the balls of your foot.
Real End-Stage Turf Toe Rehab
Sled pushes, or in this case, forward pushing on a high resistance self-powered treadmill, is a great way to work on the explosive push off required to fully get back to your sport.
Shown in these clips are of the exercises a patient of Mike’s did at his last session. He had a turf toe injury early this year that he never rehabbed, and subsequently loss big toe extension in addition to experiencing pain anytime he loaded his big toe into extension. As a rugby player, he needs the ability to push off and drive through his big toe to make tackles. From a training perspective, he had eliminated all lunges, split jerks, running, and jump roping from his programming due to pain.
Now well past the acute stages with no active inflammation, the goal then was to slowly increase big toe extension as well as tolerance to loading. We did lots of loaded stretching, heel raises, short foot balance/proprioceptive drills, and big toe motor control drills.
Fast forward to a little over a month later, he has now regained his big toe extension passively and he is able to bear full weight on his big toe in a standing position without discomfort for minutes at a time. The key to getting to this stage was volume! Tons and tons of time spent in a loaded big toe extension position.
Now, we are working on more explosive push off drills including the sled, triple extension drivers, loaded posterior lunges, pogos drills, and half-inch lift offs for maximal loading in a big toe extended position.
The goal is to get him ready for the rugby season that starts…I think he’ll be ready. And I think you will be ready too!
Thanks for reading! 🙂
Najefi, Ali-Asgar, et al. “Turf Toe.” EFORT Open Reviews, vol. 3, no. 9, 2018, pp. 501–506., doi:10.1302/2058-5241.3.180012.
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