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 injures the joint capsule and ligaments on the bottom side of the foot, leaving it very painful. While most common in footballers, there is also a high incidence of turf toe injuries in rugby and soccer players as well. This article will cover a rehab guideline for getting back on the field after an old turf toe injury.
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 toward gentle toe and ankle range of motion exercises and light strengthening exercises.
Sample Turf Toe [P]rehab Program Exercise 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.
Take Control of Your Turf Toe Pain
Are you dealing with big toe pain and not sure how to manage it? This is the program for you! This Foot & Ankle Rehab Program is a step-by-step program to help you minimize pain and optimize foot & ankle function.
Short Foot Doming
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.
Big Toe Abduction
Sample Turf Toe Rehab Program Exercise Video
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 the 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. In addition, try to be as mobile and active as possible while not overstressing the tissues. If playing sports, taping your big toe into flexion (toe pointed down), 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.
3 Easy Steps To Turf Toe Rehab
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 up) or how much load is applied with the big toe in extension (how much weight you put on it).
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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 Turf Toe Rehab Program Exercise Video
In a standing position with all your weight on your unaffected side, gently 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!
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 strengthen the injured tissues on the bottom of the foot, but they also strengthen the calf and the flexor hallicus longus.
Turf Toe Rehab Exercises for Strength
The next part of this article will depict various exercises that are excellent for strengthening after a turf toe injury!
Single-Leg Calf Raises Off Step
Sample Turf Toe Rehab Program Exercise Video
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.
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.
Half-Kneeling Lift Offs
Start in a half-kneeling position. The goal of this exercise is to work the kneeling leg. Keep your toes pointing into the ground. Keep 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.
Turf Toe Rehab Exercises For Explosiveness
After spending a few weeks working on increasing your big toe strength and the ability of 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!
Pogos Double Leg
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!
Shown in these clips are 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 lost 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. 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. 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! :)
Maximize Your Foot and Ankle Health
The foot & ankle is a truly unique design with 26 bones, 30 joints, over 100 muscles, tendons, ligaments, and over 7,000 different nerve endings! It’s complex but in complexity, we go simple because simple works! In the Foot & Ankle Rehab Program you will spend time developing the habit of consistency each week. Along with consistency, the goal is to increase confidence and decrease uncertainty by mastering safe, effective movements. As you work through the program make sure to take advantage of the education, training support, and assessments videos.
- 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.
About The Author
Michael Lau, PT, DPT, CSCS
[P]rehab Co-Founder & Chief Product Officer
Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California.
As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients.
A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place.
He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.