Background: Turf toe is a spectrum of plantar soft-tissue injuries involving the first metatarsophalangeal (MTP) joint, usually caused by hallux hyperextension. Injury severity ranges from mild sprain to complete disruption of the plantar plate-sesamoid complex. Because the first MTP joint is essential for push-off, sprinting, and cutting, delayed diagnosis may lead to persistent pain, instability, stiffness, and functional limitation. This review aimed to synthesize current evidence and outline a practical diagnostic and treatment framework. It adds value by combining diagnosis, imaging, management, and return-to-play guidance into a single practical framework for clinical decision-making.
Methods: A narrative clinical review was conducted using PubMed, Embase, ClinicalKey, PubMed Central, and Open Evidence. Searches were performed from January 20, 2026, to March 6, 2026, and captured all indexed literature meeting search criteria. English-language human studies published in 2015 or later were considered. Titles, abstracts, and full texts were screened for relevance. Evidence was synthesized narratively by clinical domain, with attention to study design, consistency, and major limitations.
Results: The literature supports a practical 3-grade classification system for diagnosis and management. Key findings included plantar first MTP pain, swelling, ecchymosis, painful or limited dorsiflexion, and instability. Weight-bearing radiographs remain first-line imaging, while MRI best characterizes soft-tissue injury severity. Grade I and most Grade II injuries are typically managed nonoperatively, whereas Grade III injuries may require surgery. Return-to-play recommendations were grade-based and criteria-driven. Evidence was limited by lower-level studies, heterogeneous methods, inconsistent grading, and variable return-to-play reporting.
Conclusion: Turf toe is a clinically significant but inconsistently studied injury. A structured, grade-based approach may improve recognition and management, but higher-quality studies are needed to standardize rehabilitation and return-to-play recommendations.
Methods: A narrative clinical review was conducted using PubMed, Embase, ClinicalKey, PubMed Central, and Open Evidence. Searches were performed from January 20, 2026, to March 6, 2026, and captured all indexed literature meeting search criteria. English-language human studies published in 2015 or later were considered. Titles, abstracts, and full texts were screened for relevance. Evidence was synthesized narratively by clinical domain, with attention to study design, consistency, and major limitations.
Results: The literature supports a practical 3-grade classification system for diagnosis and management. Key findings included plantar first MTP pain, swelling, ecchymosis, painful or limited dorsiflexion, and instability. Weight-bearing radiographs remain first-line imaging, while MRI best characterizes soft-tissue injury severity. Grade I and most Grade II injuries are typically managed nonoperatively, whereas Grade III injuries may require surgery. Return-to-play recommendations were grade-based and criteria-driven. Evidence was limited by lower-level studies, heterogeneous methods, inconsistent grading, and variable return-to-play reporting.
Conclusion: Turf toe is a clinically significant but inconsistently studied injury. A structured, grade-based approach may improve recognition and management, but higher-quality studies are needed to standardize rehabilitation and return-to-play recommendations.