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Turf Toe

Presentation, Diagnosis, and Management

Poppe, Tanner BS1; Reinhardt, Daniel MD1; Tarakemeh, Armin BA1; Vopat, Bryan G. MD1; Mulcahey, Mary K. MD2

doi: 10.2106/JBJS.RVW.18.00188
Review Articles

  • » Turf toe is a common injury in athletes. The prevalence of this injury has increased since the implementation of artificial turf and has been reported to be as high as 45% in professional football players.
  • » The mechanism of injury, first described by Bowers and Martin in 1976, is hyperextension of the first metatarsophalangeal (MTP) joint, which causes disruption of the plantar structures. Turf toe can be classified as grade I, II, or III depending on the severity of the injury.
  • » Patients typically present with tenderness, swelling, and/or loss of motion at the MTP joint. Physical examination includes palpation of the key structures surrounding the joint, along with varus and valgus stress and drawer testing of the MTP joint. Weight-bearing radiographs and magnetic resonance imaging are the most commonly utilized imaging modalities.
  • » Turf toe typically is treated nonoperatively with rest, ice, nonsteroidal anti-inflammatory drugs, and compression. Operative treatment may be indicated when nonoperative measures are unsuccessful or in patients with severe disruptions of the plantar structures. Outcomes of turf toe are generally good, but in rare cases, the injury can be career-ending.
  • » The purpose of this review is to highlight the current literature on the epidemiology, risk factors, classifications, diagnosis, treatment, and clinical outcomes of turf toe.

1Department of Orthopedics, University of Kansas School of Medicine, Kansas City, Kansas

2Department of Orthopedics, Tulane University School of Medicine, New Orleans, Louisiana

E-mail address for M.K. Mulcahey:

Investigation performed at the University of Kansas School of Medicine, Kansas City, Kansas

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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