Turf Toe

Home / Turf Toe

Expert Patient Guide · London

Turf Toe: Big Toe Joint & Plantar Plate Injury

A comprehensive patient guide by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK.

At a Glance: Turf Toe & Plantar Plate Injury

Condition	Turf toe — a sprain or tear of the strong tissue and ligaments under the big toe joint, caused by the toe being bent too far upwards.
Who It Affects	Most common in athletes — football, rugby, martial arts, gymnastics, dance and running. Can also occur in everyday trauma.
Most Common Cause	Body weight driving down through a big toe that is planted and bent upwards — often on firm artificial pitches, in soft, flexible shoes.
Diagnosis	An examination to test the joint for looseness, X-rays taken standing, special views of the small bones under the toe, and an MRI scan. Standing (weight-bearing) CT scans are used more and more.
Grading	Grade 1 (mild sprain) to Grade 3 (complete tear of the tissue under the joint); some systems add Grade 4 when a bone is injured as well.
Non-Surgical Care	Rest, ice, taping, a stiff-soled shoe or turf toe insert, a walking boot and step-by-step rehabilitation. This suits most Grade 1 and Grade 2 injuries.
Surgical Options	Repairing the torn tissue under the joint, fixing or removing one of the small bones, and straightening the toe — for unstable Grade 3 injuries or a toe knocked out of line.
Recovery	Back to sport in a few days for mild injuries, or 8–12 weeks and sometimes longer after surgery. Severe injuries can take 6–12 months to settle.
Specialist	Mr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

What Is Turf Toe?

Turf toe is an injury to the big toe joint — the joint where the long bone of the foot meets the base of the big toe (doctors call it the first metatarsophalangeal, or MTP, joint). It happens when the toe is forced too far upwards, spraining or tearing the strong band of tissue underneath the joint known as the plantar plate.

Underneath the joint sit two small bones called the sesamoids. They sit inside the tendons that bend the toe and are joined to the toe by the plantar plate. Together these parts hold the joint steady and give you the push-off power you need to walk, run and jump. When they are injured, even simple activities such as walking or climbing stairs can become painful.

The name comes from its link with sport played on firm artificial surfaces, but turf toe can affect anyone. If it is missed, it can leave the toe stiff, unstable or bent out of shape, and can bring on arthritis of the big toe joint earlier in life. Seeing a specialist foot and ankle surgeon — such as Mr Matthew Welck in London — gives you the widest choice of treatments and the best chance of a full recovery.

Who Gets Turf Toe?

Turf toe is primarily a sports injury. It was first described in American football players, where teams reported around five to six of these injuries each season after they moved to artificial pitches and lighter, more flexible boots.

It is now recognised across a wide range of activities, including:

Football and rugby
Martial arts, taekwondo and jiu-jitsu
Gymnastics, dance and ballet
Running, basketball and racquet sports

In the UK, turf toe is far less common than in American football. Studies of professional rugby union show it makes up only a small share of foot and ankle injuries, and in English football it is rarer still. This is probably because most pitches here are natural watered grass, and because boots and playing styles differ. Even so, it is an important injury in active people, and one that is often missed.

What Causes Turf Toe?

It usually happens when your body weight drives down through a big toe that is planted and bent upwards — for example, pushing off hard from the toe, or another player landing on your heel while your foot is flat and your toe is fixed on the ground. This bends the joint too far back and damages the plantar plate and the lining of the joint.

Common contributing factors

Firm artificial pitches — the shoe grips the surface more, so the foot stops suddenly
Flexible footwear — soft-soled shoes let the toe bend too far
Sudden push-off, sharp changes of direction and twisting on the spot
A direct blow or fall onto the bent toe

The injury can vary. A force from the side can damage the ligaments on the inside of the toe and push it outwards, creating a bunion caused by injury (hallux valgus). A force in the opposite direction can damage the structures on the outside and cause the toe to drift the other way. A related injury, “sand toe”, happens when the toe is forced downwards instead — usually during barefoot activities such as beach sports.

What Are the Symptoms?

Turf toe is easy to miss, and it can range from mild to severe. Common symptoms include:

Pain at the base of the big toe, worse when you push off or put weight on it
Swelling and bruising around the joint and the ball of the foot
A stiff big toe that is painful and does not bend as far as usual
Tenderness underneath the joint, over the plantar plate and the small sesamoid bones
A feeling of instability or “giving way” in more severe injuries
Difficulty running, jumping, cutting or wearing normal shoes

As a rough guide, if the tender spot is behind the small sesamoid bones, the injury is usually milder. If it is in front of them, nearer the toe, the injury may be more serious and the joint may be unstable. If the toe is very swollen, looks out of shape, or you cannot put weight on it, you should be seen by a specialist urgently.

What Investigations Might You Need?

Getting the diagnosis right depends on hearing how the injury happened, examining the toe and choosing the right scans:

Examination of the joint — gently moving and pushing the toe in different directions to see whether it is loose, and to check the ligaments on each side
X-rays taken standing — several views of both feet, so the injured side can be compared with the other and the position of the small sesamoid bones checked
Extra X-ray views — if a sesamoid bone has been pulled backwards, the plantar plate is probably torn, and an X-ray taken with the toe bent upwards can show an unstable joint
MRI scan — the most useful test for showing how badly the soft tissues are injured, and for checking the plantar plate, sesamoid bones, cartilage and any bruising of the bone
CT and standing (weight-bearing) CT scans — increasingly useful for looking at breaks in the sesamoid bones and at how the joint lines up, and a particular area of Mr Welck’s expertise

Good scans also help tell a true break in a sesamoid bone from one that is naturally in two parts — a common and usually harmless variation that some people are simply born with.

Non-Surgical Treatment Options

Most turf toe injuries — nearly all Grade 1 and Grade 2 injuries, and many Grade 3 — get better without surgery. Treatment starts the same way whatever the grade: rest, ice, gentle compression and keeping the foot raised for the first 48–72 hours.

Staged, grade-based rehabilitation

Grade 1: the toe is taped in a slightly downward position, a stiff-soled shoe or insole is used to stop it bending, and you build back up to gentle activity within a few days
Grade 2: a short spell of walking in a protective shoe or boot — usually about two weeks off sport — then a gradual return as the pain settles
Grade 3: a longer spell resting the toe in a walking boot or cast, often up to eight weeks, before going back to running or jumping

A stiff-soled shoe, or a thin carbon-fibre plate inside the shoe, stops the toe bending painfully upwards while the plantar plate heals. Before you go back to running or explosive sport, the big toe should bend upwards about 50–60 degrees without pain. Severe injuries can take six to twelve months to settle completely, so it is important not to underestimate what can look like a “minor” toe injury.

Surgical Options for Turf Toe

Surgery is rarely needed, but it matters for the small number of injuries that are unstable or that do not settle. Any plan is tailored to you — the pattern of your injury, what you want to get back to, and how active you are.

When surgery is considered

A large tear where the joint lining has pulled away, leaving the joint unstable
A sesamoid bone that has been pulled out of place, split apart or broken
A toe that moves up and down too freely, loose fragments inside the joint, or damaged cartilage
A bunion, or a toe that has drifted out of line, caused by the injury (hallux valgus or hallux varus)
Pain that carries on despite non-surgical treatment

Plantar Plate & Capsule Repair

The torn plantar plate and joint lining are repaired through a small cut under the toe or on its inner side. Strong stitches, and sometimes tiny anchors placed in the bone, are used to reattach the tissue to the base of the toe. This gives the joint back the stability you need to push off.

Sesamoid Surgery

A broken sesamoid bone can be repaired or, if needed, partly removed, keeping as much of the bone as possible. Removing a sesamoid completely is avoided wherever it can be, because taking out both of them weakens push-off and can pull the toe out of shape. If a sesamoid does have to be removed, moving a tendon into a new position can help keep the toe stable.

Deformity Correction

If the injury has left a bunion, or made the toe drift the other way, the soft tissues are rebalanced and sometimes the bone is cut and reset (an osteotomy) to straighten the toe. After surgery the toe is protected in a splint or boot, then rehabilitation builds up in stages, with a turf toe plate in the shoe to stop the toe bending too far while it heals.

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading specialist orthopaedic hospitals — and Honorary Associate Clinical Professor at UCL.

His practice is dedicated exclusively to foot and ankle surgery, with a special interest in sports injuries, complex rebuilding operations, redoing previous surgery and ankle replacement. He has written more than 50 published research papers, completed two specialist training fellowships including time abroad, and helped pioneer standing (weight-bearing) CT scanning and 3D-printed, made-to-measure surgical guides for complex deformity.

He sees patients across North and Central London, with quick access to MRI and standing CT scans and to a wider team of specialists. Every option is explained openly, and you agree a plan together that suits you. Visit matthewwelck.com to learn more.

Frequently Asked Questions

What is turf toe in simple terms?

Turf toe is a sprain or tear of the ligaments and soft tissue under the big toe joint, caused by the toe being forced too far upwards. It ranges from a mild sprain to a complete tear that makes the joint unstable.

How long does turf toe take to heal?

Mild (Grade 1) injuries often settle within days to a couple of weeks. Grade 2 injuries typically take four to six weeks. Severe (Grade 3) injuries — and those needing surgery — can take several months, and the most serious can take six to twelve months to fully recover.

Can turf toe heal on its own?

Many turf toe injuries heal without surgery using rest, taping, a stiff-soled shoe or boot, and staged rehabilitation. However, it is important not to underestimate the injury, as returning too soon can worsen it. Unstable or severe injuries may need surgical repair.

Do I need surgery for turf toe?

Most people do not. Surgery is kept for unstable Grade 3 injuries, a broken or displaced sesamoid bone, loose fragments in the joint, a toe left out of shape by the injury, or pain that carries on despite non-surgical treatment. A specialist assessment will tell you which group you are in.

What is the difference between turf toe and a sesamoid injury?

They often occur together. Turf toe means damage to the plantar plate and the lining of the big toe joint. A sesamoid injury involves the two small bones underneath the joint. An MRI scan and a specialist examination show exactly which parts are affected.

When can I return to sport after turf toe?

Return depends on the grade. The big toe should have around 50–60 degrees of pain-free upward movement before running or explosive sport. This may be a few days for mild injuries, a few weeks for moderate ones, and 8–12 weeks or longer after severe injury or surgery.

Can turf toe cause long-term problems?

If it is not treated, turf toe can leave the toe stiff, unstable or out of shape, and can bring on arthritis of the big toe joint (hallux rigidus) earlier than usual. Getting the right diagnosis and treatment early gives the best chance of avoiding these problems.

Where can I see Mr Matthew Welck for turf toe treatment in London?

Mr Welck consults across North and Central London. NHS patients are seen at the Royal National Orthopaedic Hospital (RNOH) Stanmore. Private appointments can be booked on 07547 395270 or by emailing secretary@matthewwelck.com.

Book a Consultation

If you have big toe pain, swelling or a feeling that the joint is giving way after an injury, seeing a specialist can make a real difference. Being seen early gives you the widest choice of treatments and the best long-term result.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon.

Book an Appointment View All Treatments

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated August 2026

Medically reviewed clinical guidance. This guide is for general information and does not replace individual medical advice.