As is clued in by its name, turf toe is an acute injury of the foot primarily seen in athletes that engage in high-impact or full-contact sports.
Like many other acute physiological injuries, ensuring proper rehabilitation takes place via gentle exercise and mobility work is paramount to returning the athlete to their original physical abilities.
The exercises used to rehabilitate turf toe primarily involve stretching and placing light resistance on the lower extremities of the kinetic chain, with exercises like heel raises and lunges being more suitable for the latter stages of rehabilitation, and arch domes or toe extensions being gentle enough for early rehab work.
Turf toe is a soft-tissue injury of the MTP joint of the foot, often characterized by reduced mobility of the large toe and acute pain around the base of the big toe’s first joint.
Turf toe is most frequently seen in participants of athletic sports (particularly rugby or American football), but can also be caused by practically any situation involving hyperextension of the toes - and is markedly more common in individuals with a previous history of plantar injury.
Due to the non-specific nature of turf toe’s symptoms, it can often be confused for other types of injury by the untrained eye, and it is best to seek the advice of a physician rather than assuming your injury is or is not turf toe.
The goal of performing exercises chosen for turf toe is to ensure that the patient does not lose mobility, strength or circulation as they undergo the necessary rest period.
Note that this period is separate from the rest period of inactivity prior to beginning rehabilitation, as performing any sort of stretching or exercise too soon can easily worsen turf toe. Depending on the severity of the sprain, this period of rest can last for up to several weeks.
Once the patient has been cleared to begin rehabilitating their turf toe injury, they are often advised to start with no-impact and non-resistance exercises meant to improve venous circulation to the area, as well as to recondition the tissues back to their full range of motion.
After it has been established that the injury has healed enough to allow for more intense movement, the rehabilitation program will transition to low-resistance and dynamic exercises meant to reinforce the muscle and tendons of the foot, eventually resulting in full recovery of the patient’s physical abilities.
A basic mobility exercise that may be performed with no equipment and in a sitting position, toe flexion and extension is meant to be employed during the early stages of turf toe rehabilitation so as to aid in retaining full plantar mobility and to improve blood flow to the injury.
Toe flexion and extension is meant to be incorporated into the beginning of a turf toe rehabilitation program, especially when combined with other low-impact exercises that can aid in retaining the function of the injured joint.
To perform toe flexion and extension, the patient will simply sit on the floor with their legs extended ahead of them, the soles facing forward and the heels resting at a natural angle on the ground.
Then - ensuring no pain is experienced - the patient will bend their toes forward, ensuring that they are maximizing the full range of motion of their big toe and bending it as far as possible.
Once reaching the end of their range of motion, the patient will then reverse the direction, moving the toes back towards their legs.
Repeat this motion in a slow and controlled manner as many times as is needed, ensuring that no pain is experienced at any point through each repetition.
Resistance band toe stretches are a low-resistance exercise meant to return strength to the muscles of the injured area.
For patients without a resistance band, other items that can wrap around the big toe such as towels or handkerchiefs may also be used.
The resistance band toe stretch is meant to be used during the dynamic recovery stage of physical rehabilitation, once an appropriate period of inactivity has passed so as to allow the tissues of the joint to recover sufficiently.
To perform a resistance band toe stretch, the patient will sit in a chair with their injured leg before them, knee bent so as to draw the foot within arm’s reach.
Wrapping a resistance band around the toes, the patient will then gently pull the band backwards, bending their toes towards the knee as they slowly extend the leg forward simultaneously.
If at any point the patient encounters hard resistance or pain during this movement, they should immediately halt the stretch.
Once the toes have been stretched to their full range of motion, the patient will simply hold this position for several seconds before slowly returning the foot to its original state. Repeat this stretch as many times as prescribed.
A very low impact exercise meant to reinforce the injured MTP joint, the arch dome exercise is also referred to as the “short foot” exercise or “foot doming” and is usually performed in the field of sports rehabilitation.
The arch dome exercise is considered to be very low impact and generally appropriate for nearly any stage of turf toe rehabilitation, though it may aggregate particularly severe levels of such an injury. In order to ascertain whether performing this movement is appropriate, it is best to seek out the advice of a physical therapist or physician.
The arch dome exercise can be incorporated at any point during turf toe rehabilitation, so long as moderate mobility and strength has been established in the injured joint.
It should be noted that the arch dome involves a shortening of the midfoot, and can cause any concurrent injuries of the rest of the foot to become worse if not otherwise accounted for.
To begin performing the arch doming exercise, the patient will stand barefoot on a flat surface with both feet facing forward in line with the knees.
Then, shifting their weight to their uninjured leg, the patient will “shorten” their midfoot by attempting to increase the arch of the foot, drawing it upward while maintaining contact with the floor through the heel and large toe.
From a sideways view, this will appear as the arch rising upwards and the toes digging into the floor, with the tendons of the ankle potentially being visible as extending forward in certain patients.
Once this elevated arch or “dome” has been achieved, the patient will hold the position for several counts before returning to their starting position flat-footed on the floor.
If at any point the patient experiences pain or tingling during this exercise, it is best to immediately cease the repetition.
Heel raises are a basic resistance exercise encountered in both athletic training and physical rehabilitation, wherein the former discipline utilizes the exercise for development of the calf muscles, and the latter discipline utilizes heel raises as an end-stage rehabilitation tool of certain plantar injuries.
This turf toe exercise places the bodyweight of the patient on the joints of the foot, meaning that it directly applies pressure and resistance to the injured site, and must be performed with caution and care.
Heel raises are meant to be used as an end-stage rehabilitation exercise for turf toe, meaning that they will generally only be performed by the patient once it has been established that they are nearing full recovery from their injury.
Performing heel raises too early in the recovery process may result in the injury worsening or otherwise healing incorrectly, potentially limiting future ability.
Standing with the feet hip-width apart, the exerciser will raise themselves upwards by the balls of their feet with their heels entirely off the ground.
Then - once again entirely avoiding any pain - the exerciser will push through their forefoot, extending until they have reached the limit of their range of motion.
Having achieved this, they will then slowly lower themselves until their heels return to the floor. Repeat as prescribed.
Bodyweight lunges are a compound resistance exercise that make use of the entire lower kinetic chain, often being performed by exercisers or end-stage physical rehabilitation patients for the purposes of strengthening lower body musculature.
Much like other higher-intensity exercises meant to help rehabilitate a turf toe injury, bodyweight lunges should be performed in a slow and controlled manner after the patient has regained sufficient strength and mobility in the injured area.
Furthermore, in the event that any concomitant injuries are present in the spine or lower body, it is best to avoid bodyweight lunges until further rehabilitation has been achieved.
Due to the intensity and pressure that lunges will place on the MTP joint, lunges are meant to be an end-stage exercise nearing the end of a physical rehabilitation program.
Performing lunges too early in the course of a patient’s recovery can result in the injury worsening or failing to heal properly, potentially sabotaging their chances of fully retaining plantar movement.
To begin performing bodyweight lunges, the patient will stand on a flat surface with their feet set approximately hip-width away from one another.
Then, flexing the core and facing their head forward, they will perform an exaggerated step forward, bending the front knee and straightening the unmoved knee until it is parallel with the floor, aligning with the toes.
To further improve mobility of the injured area, the patient may hinge on the ball of their foot, stretching the toes as they hold the bottom of the lunge position.
Once the motion is complete, they will then repeat it with the legs switched, thereby completing a repetition.
The majority of turf toe exercises have one thing in common - they target the injured area directly, stressing or otherwise manipulating the joint in a manner that signals to the body the need for tissue recovery.
Ensuring that this recovery is maximized comes with several other matters as well; the patient should always keep the foot out of any situation that may place uncontrolled or sudden pressure upon it, as well as the fact that they should maintain a lifestyle that is conducive to proper injury recovery.
Factors like sleeping for an adequate length of time and consuming sufficient food will be just as important as performing rehabilitative exercise, with any neglect of these aspects potentially slowing the patient’s recovery.
And as always, it is important to consult a physician if you suspect that you have turf toe or a similar injury, as there are many possible causes of foot pain that can only be differentiated through diagnostic equipment.
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