By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HUSBAND’S ACHING TOE MAY BENEFIT FROM REST, ICE AND ELEVATION

Question: My husband has started running at the gym, on the treadmill and at the track. Recently he started having pain in the base of his big toe. His buddy told him it sounded like “turf toe.” Is this a real medical condition, and if so, what can he do about it?

Answer: Your husband may very well have “turf toe,” which is a real medical condition. In case you feel that such commonplace nomenclature isn’t befitting a real disease, you’ll be happy to know that turf toe actually does have an official polysyllabic, tongue-twisting, medical sounding name -- metatarsophalangeal joint sprain. In fact, understanding this doctor jargon will help you understand what takes place when one gets turf toe.

The joint at the base of each toe is called the metatarsophalangeal (MTP) joint. In the first, or “big” toe, this joint can become injured when you bend it backwards (hyperextend) during exercise. Sometimes this happens with just one major trauma to the toe. You may, for instance, make a quick cut and change direction on the football or soccer field and, thereby, jam your toe into the turf or ground and bend it too far backwards. At other times, as might be more likely in your husband’s case, it is repeated smaller injuries that cause turf toe.

This bending past the optimal range of motion is seen most often in athletes who run or jump on artificial turf -- hence the name, turf toe. However, basketball players and those working out in gyms can also get turf toe. In these cases, perhaps we ought to call it “court toe,” and “gym toe.”

By whatever name you call it, the primary symptom of this disorder is pain in the MTP joint at the base of the big toe. If left untreated, it can also cause swelling and stiffness of the toe. In severe cases, the pain may be so bad that it causes you to limp and prevents you from running.

In turf toe, the force of the initial injury or the repeated trauma is often strong enough to actually tear the capsule that surrounds the MTP joint. If left untreated, this can lead to instability of the big toe joint. It can also cause arthritis to develop in the affected joint. Since the big toe plays a major role in enabling us to walk, chronic pain in this joint can be quite debilitating.

Diagnosis is usually made by history of an MTP joint injury or of continued impact to the joint with running or jumping. An X-ray will rule out a fracture to the area. Treatment is usually just rest, ice and elevation of the painful toe. If your husband’s doctor does diagnose him with turf toe, he will probably be told to stop running or jumping for about three weeks to promote healing of his damaged MTP joint. His doctor may also recommend an anti-inflammatory medication such as ibuprofen.

When full activity is resumed, some people use special inserts that prevent bending of the MTP joint of the big toe. As a way to test whether an orthotic insert might help, a friend of mine who is a podiatrist suggested running in hiking boots to prevent motion of the MTP joint. If you can run in the boots without turf toe pain returning, mention that your doctor. He or she can prescribe an appropriate orthotic device for you. If that experiment doesn’t work, it would be wise to mention that to your physician as well.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.