You may have heard about Derrick Rose, the Chicago Bulls All-Star guard who missed three straight games because of pain in his big toe. It’s hard to imagine that a simple toe injury could sideline a strapping, world-class athlete. But anyone who has had “turf toe” knows how debilitating it can be. And it doesn’t just sideline athletes. Anyone can be affected by this type of injury, which is known off the playing field as a sprain. Fortunately, there are some simple—but highly effective—strategies for faster healing of this common injury…
Turf toe, as the name suggests, tends to occur in athletes who play on artificial grass. The turf grips the bottoms of their flexible athletic shoes. This is good for traction, but it also can “trap” the foot when players move at high speeds and sharp angles, forcing the big toe to bend sharply upward.
Of course anything that forces the toe joint to hyperextend, or bend too far upward, can stretch or tear ligaments and sometimes damage the joint itself.
Among nonathletes, this usually occurs in the first or second joints of the big toe. It’s often due to footwear. Shoes that are very soft don’t provide enough support to prevent excessive joint movement.
Age plays a role, too. After about age 50, the ligaments have stretched, and there is less fat padding the bottom of the feet.
WHAT GOES WRONG
When you’re walking or running, the big toe is the last part of the foot to leave the ground. On “push-off,” up to eight times your weight is transferred to the first joint of the big toe, and the toe easily can be forced beyond its normal range of motion.
Result: The ligaments stretch and may tear slightly or—if the sprain is severe—completely rupture.
You don’t have to see a doctor right away if you think you have a mild or moderate sprain. Take care of it yourself (see below) for a week to 10 days. If it seems to be getting better—there’s a daily decrease in pain and swelling—it probably will heal on its own.
Your doctor usually can diagnose a sprain just by asking about the history of the injury and seeing where and when it hurts. Imaging tests such as X-rays or MRIs are needed only if your doctor thinks the sprain is severe and that there might be bone damage.
For faster healing…
Take an anti-inflammatory, such as ibuprofen (Advil) or naproxen sodium (Aleve), following the directions on the label. It will decrease inflammation, helping to heal the injury. It also will reduce pain.
Rest. Sprains heal slowly because the connective tissues have a limited blood supply. It can take weeks or even months for the damaged tissues to repair. Resting the joint is critical—keep your weight off the foot as much as possible. You may want to use crutches or at least elevate the foot on a pillow whenever you’re sitting down. Elevating the foot decreases swelling and thus promotes healing.
Also important: Frequently ice the area on the first day after the injury. This reduces inflammation. You can use a cold pack, available in pharmacies, or wrap ice cubes in a small towel and hold them on the joint for 15 to 20 minutes at a time. Ice as frequently as you want as long as the area warms in between and there is normal sensation.
Splint the toe with a buddy splint. Loosely tape the big toe to the toe next to it. This will keep it more stable and accelerate healing. Put a strip of gauze under the tape to prevent chafing.
Helpful: You can buy a stiff-bottomed shoe, known as a postoperative shoe, in a pharmacy. It will keep the toe from flexing. Cost: About $20.
Exercise the toe. When the pain and swelling are gone, exercise the toe to strengthen muscles and restore its normal range of motion. Examples: While sitting, use the toe to trace an imaginary alphabet…or put a towel on the floor, and repeatedly pick it up with your toes.
SHOES FOR PREVENTION
Nonathletes who injure the big toe usually can blame their shoes. In New York City, I often see women rushing around in ballet flats. They’re comfortable and lightweight but offer no support—and no protection from concrete sidewalks and curbs.
Similarly, women who wear high heels are putting a lot of unnecessary pressure on the big toe—they’re forcing it to hyperextend. It’s fine to wear heels on special occasions but risky when you’re doing a lot of walking.
In general, women should wear firm shoes with relatively low heels. Men do better with firm but lightweight shoes, such as those made by Rockport, rather than with stiff dress shoes.
Also helpful: You can add protection to any shoe by using an over-the-counter neoprene insert. They’re inexpensive and add support and cushioning.