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Patrick Mahomes has “turf toe” and has not been at 100%. The injury was sustained during the AFC playoff game against the Cleveland Browns and was limiting his ability to escape the pocket. Fortunately, he was able to perform well enough to defeat the Buffalo Bills, but the limiting effects of the injury were obvious. I get asked frequently what exactly is turf toe, why is it so painful and when does it need surgery.

Turf toe is an injury to the ligaments that hold that big toe joint together. Classically this occurs in the tissues that are underneath the big toe joint where a bundle of ligaments form together to form what is called the plantar plate. A turf toe occurs when the big toe hyperflexed and creates a tear to the plantar plate.

Like many sprains, turf toe can have different grades. A mild sprain is usually just a little sore but can be treated with a special insert, taping, anti-inflammatories, and little missed time. A severe sprain results in a complete tear of the plantar plate and has a much longer recovery. Usually, these require surgery to go in and surgically repair the tissues back together. If it is not fixed, the lack of the ligament can make the joint unstable and cause deformity, stiffness, and arthritis. 

With the athletes I see with a suspected turf toe injury, I usually start by getting X-rays and a physical exam. I have found that one of the best tests is standing X-rays of both feet side by side. This allows me to compare the two feet. 

There are tiny pea-shaped bones under the big toe called the sesamoids. I compare them to the knee cap of the big toe. Part of the plantar capsule attaches to the bones. When the capsule completely tears, these bones will shift and a difference in their position from one side to the next can indicate a tear of the ligament. MRI is also frequently done and helps evaluate the extent of the injury in greater detail.  

(The picture on the right shows the sesamoid bones in a normal position – red circle. The image on the left shows them moving toward the ankle indicating a disruption of the turf toe capsule.)

In terms of treatment, most of the mild sprains can be treated nonoperatively. In addition to anti-inflammatory medications, rest, ice, and elevation, I will use a special insert that has a carbon fiber plate that minimizes the amount of stress placed on the injured ligament. It was reported the Patrick Mahomes used a device similar to the one below during the AFC championship.  

In cases where the ligament is completely torn, I will recommend surgery to repair the ligaments in an effort to help stabilize the big toe which decreases the risk of arthritis and deformity. It is very common for these injuries to result in some limited range of motion.

If you suspect that you may have turf toe and would like it evaluated, let us know. We would be happy to consult with you and provide some recommendations for treatment.

Physician Reference: 
Nicholas L. Strasser, MD