The San Diego Chargers star running back, LaDainian Tomlinson, has been hampered all season by an early turf toe injury. This injury can be devastating and has ended many NFL careers. What is turf toe really? How can we avoid this pain in the toe? What is turf toe? Turf toe is a condition of pain in the base of the big toe. This usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible. This injury is especially common among athletes who play on artificial turf, hence the name. The hard surface combined with running, jumping and cutting in football and soccer, make turf toe a frequent injury. Some also blame the choice of athletic footwear. The more flexible shoes, especially used in competition, provide less support to the forefoot joints, possibly contributing to the incidence of turf toe. How does turf toe occur? When a player sustains this kind of toe injury they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as Hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely. How is turf toe diagnosed? Diagnosis is based primarily on the physical examination of the patient. X-rays may be taken to ensure there is no fracture or evidence of arthritis. Occasionally an MRI is needed to evaluate the surrounding tendons or to rule out an occult stress fracture. What is the treatment of turf toe? Treatment of toe injuries usually consist of trying to control the inflammation of the joint capsule. Treatment protocol can include: 1. Rest 2. Ice 3. Elevation 4. Taping or padding to off-weight the toe joint 5. Anti-inflammatories 6. And in chronic cases steroid injections to the joint may be helpful 7. Long term use of a functional foot orthotics to balance the forefoot in the cleats is quite helpful. Athletes diagnosed with turf toe should avoid stress to the joint for three to four weeks to allow the joint capsule to heal. Once returning to activities, functional orthotics can be used to limit the motion of the big toe and prevent further damage to the joint capsule. Will turf toe return? Unfortunately, turf toe can return, often more severe than the initial injury, and rehabilitation may be very slow. LaDainian Tomlinson has been slowed by his injury all season and most likely will not be 100% until he can rest at the end of the season. Most athletes have trouble when they try to come back to sports too soon after sustaining a turf toe injury. Surgery is rarely needed for treatment of turf toe unless this has been a chronic injury and spurs are present in the joint limiting motion. If a bone spur has formed, and severely limits the motion of the toe joint, surgery to remove the spur may be helpful. Prevention and early treatment is really the key! If you are experiencing pain in the joint after running in practice, your shoes should be evaluated for a functional orthotic to balance your biomechanics and hopefully avoid significant turf toe.