Turf toe is a sprain of the plantar plate and capsular structures of the first metatarsophalangeal (MTP) joint produced by forceful hyperextension (dorsiflexion) of the great toe, often when the heel is raised on a hard playing surface and the toe is fixed on artificial turf. The plantar plate, joint capsule, sesamoid complex, flexor hallucis brevis, and adductor and abductor hallucis can all be injured. Severity is classified into three grades: grade I (stretching without tearing), grade II (partial tear with pain on motion), and grade III (complete plantar plate rupture, often with sesamoid fracture, displacement, or articular injury).
Symptoms include pain at the plantar base of the great toe, swelling, ecchymosis, painful push-off, inability to perform full hyperextension, and weakness of toe-off. Examination evaluates passive and active range of motion, varus-valgus stability, sesamoid tenderness, and palpable defect in plantar plate; Lachman test for the MTP joint detects gross plantar plate rupture. Imaging includes weight-bearing AP and lateral radiographs to look for sesamoid fracture or proximal migration, MRI to delineate plantar plate tear, and bone scan in occult cases.
Grade I and II injuries are treated with PRICE (protection, rest, ice, compression, elevation), turf toe taping or carbon-fiber stiff insoles, NSAIDs, and gradual return to play in 2-6 weeks. Grade III injuries with complete plantar plate rupture, sesamoid retraction, or articular incongruity require surgical repair (open plantar plate repair, sesamoid fixation, or partial sesamoidectomy) to restore push-off mechanics. Persistent pain may indicate hallux rigidus, sesamoiditis, or osteochondral lesion. Athletic footwear with stiff forefoot, taping, and toe spica protection are key for return to play.