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This article is from the In-Depth Report The Science of Football

What is turf toe?

Russell Warren, a professor of orthopedics at Weill Cornell Medical College and the team physician for the defending Super Bowl-champion New York Giants, explains:



iStockphoto/Bill Grove

For football players, turf toe is a common malady that is more of a nuisance than a serious injury. Even though it's linked to artificial surfaces found in most domed stadiums (hence its name), players can get turf toe on grass, as well as any other firm surface.

So, what exactly is it?

Turf toe is actually a constellation of injuries typically involving the stretching of tissue inside the big toe. You can get it by stubbing the toe against a surface, hyperflexing it (over-curling it toward the sole of your foot), or hyper-extending it (jamming it back towards your body).

Any player on the football field is at risk of turf toe, from wide receivers to linebackers. I see it in linemen—particularly the ones on the ends of the line. Why are they vulnerable? The classic way is if you imagine a lineman while he is blocking. If that player gets overpowered and his knee is down on the turf and his foot is out behind him, and he falls back on his foot or somebody else falls on it, smashing the toe into the ground and hyperextending it.

The wrenching motions cause inflammation—swelling and stiffness—of the joint where the toe attaches to the rest of the foot, leading to difficulty moving the toe. We'll often try to reduce the swelling and get movement in the joint back by icing the injury or treating it with ultrasound—which stimulates the tissue and causes increased blood flow to the area to speed healing. If motion around the joint is lost, tweaking it becomes easier and turf toe can become a chronic problem, sidelining some players for up to a month.

The injury is typically very manageable and does not sideline a player at all. In extreme cases, however, there are several different injuries players can sustain: They can tear ligaments at the joint between the toe and the foot, sprain the joint or injure cartilage underneath the toe, separating it from the bone—by cracking or splitting it. In rare cases, two little bones on the balls of your feet behind the big toe called sesamoids—which are like little knee caps—can stiffen and begin throbbing or, worst-case scenario, fracture.

If a player gets turf toe—and we don't make any protective changes—the chance of him sustaining stress fractures and breaks in his foot increases. To protect against re-aggravating the injury, we'll get them firmer shoes or put a thin, steel plate in the bottom of the shoe to take some of the flexibility out of the tip of the shoe.

Turf toe isn't all that different from jamming your finger. In the latter case, you normally just tape the sprained finger to the one next to it and go on with your day. What makes turf toe so much more of a pain is that it bothers you with every step you take.

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