The Science of Turf Toe

Turf toe represents a traumatic injury to the capsuloligamentous complex of the first metatarsophalangeal joint, most commonly involving the plantar plate, joint capsule, and associated ligamentous structures. The injury occurs when the great toe is forced into excessive dorsiflexion beyond its normal physiological range, typically during explosive athletic movements. The plantar plate serves as the primary restraint to hyperextension of the first MTP joint, working in conjunction with the joint capsule and collateral ligaments to provide stability. When these structures are subjected to forces exceeding their tensile strength, injury occurs along a spectrum of severity. Grade I injuries involve stretching of the capsuloligamentous structures without macroscopic tearing, while Grade II injuries demonstrate partial thickness tears with some structural compromise. Grade III injuries represent complete disruption of the plantar plate and associated structures, often with involvement of the sesamoid complex. The sesamoid bones, which are embedded within the flexor hallucis brevis tendon and plantar plate, may be fractured, displaced, or avulsed from their normal position. This level of injury significantly compromises the biomechanical function of the great toe and can result in chronic instability if not properly managed. The injury mechanism typically involves the foot being planted in a fixed position with the metatarsophalangeal joint in slight dorsiflexion, followed by a sudden force that drives the toe into extreme hyperextension. This commonly occurs on artificial turf surfaces where the increased coefficient of friction prevents normal foot sliding, concentrating forces at the great toe joint. The term "turf toe" derives from this association with artificial playing surfaces, though the injury can occur on any surface and in non-athletic populations.