With the turf toe injury to Jose Bautista this summer, many people are asking “What is turf toe?”.  Bautista sustained an injury to his 1st metatarso-phalangeal joint (where his big toe articulates with the foot).  This is a soft tissue injury to the ligaments around the joint which are sprained when the big toe is hyper-extended.  As you can imagine, athletes do a lot of bending of the big toe joint (yes, even baseball players).

The treatment for turf toe is conservative in nature.  The injury has to heal, so there will be a time of reduced weight-bearing and immobilization of the joint so the athlete does not aggravate the injury when walking.  Physiotherapy to promote healing of the soft tissues is important, as athletes want to get back to playing as quickly as possible.

When it is deemed that an athlete with a turf toe injury is ready to return to practice, a therapist will often tape the toe to minimize stress to the big toe joint and surrounding ligaments.  At Align Orthotics and Rehab we use Dynamic Tape which has an elastic recoil to help the rest of the foot absorb some of the forces acting on the big toe.

An example of taping a turf toe using Dynamic Tape (image from Dynamic Tape Facebook page)

In cases where the symptoms are persistent, or re-injury has occurred, a custom made orthotic can be fabricated to control dorsiflexion of the big toe.  Forces several times the athlete’s body weight are borne by the big toe and its main joint, during propulsion.  Sports that require pushing off (most sports) can aggravate a turf toe injury and make it difficult for an athlete to sustain their performance.  In this specific case, we will fabricate an orthotic with a rigid hallux extension (the shell of the orthotic extends under the big toe).  This does not sound particularly comfortable, and you might ask whether you could wear such an appliance playing sports, but you can!  If the orthotic is made properly so that the extension fits smoothly under the big toe (and we add some padding) this device can be worn for sports.

One of these orthotics has a rigid hallux extension, and the other does not. Can you tell the difference?