Feet > Turf Toe > Treatments

   Surgery

Treatment Introduction

Severe turf toe can be a season-ending injury. It may cause bone spurs or loose bodies in your big toe’s joint with your foot, which can hinder your toe’s movement and cause pain. Surgery to remove the bone spurs or loose bodies may be necessary to relieve turf toe pain. You may become a candidate for surgery if you have suffered turf toe in the past and conservative treatment has failed to relieve your symptoms. Bone spurs in your big toe joint are your body’s response to cartilage damage in the joint. When the cartilage is damaged, your body forms bone spurs as a sort of roadblock to movement in the joint space between your big toe and the longer midfoot bone (first metatarsal). If the joint cannot move, the bones cannot grind into each other as much. However, moving your big toe can cause pain and activities can become difficult. Your surgeon can cut away the bone spurs, restore movement in your big toe, and relieve pain.

The actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher rate of infections and complications.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or an assistant about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your foot may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You typically have a chance to meet the whole surgical team, including the nurses, before the procedure begins. You will have the opportunity to speak with your orthopedic surgeon or an assistant and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This helps reduce the risk of vomiting while you are under anesthesia.

   Arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your toe-immobilizing shoe when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery to remove bone spurs or loose bodies from your big toe usually takes about 1 1/2 hours to perform. A regional ankle block anesthesia is injected into your ankle to numb your foot and you usually are sedated so you sleep through the procedure.

   An incision about three centimeters long usually is made along the top of your big toe.

   Your surgeon inspects your big toe’s joint with your foot. Bone spurs often grow from the small bones in the ball of your foot called the sesamoids.

   Any loose bodies or bone spurs that are hindering joint movement are cut away, or excised, so that your big toe’s joint can move normally.

   Tendons or ligaments that have torn can be sewn together.

   Your incision is closed with stitches. A plaster splint is applied to immobilize your toe, and you are taken to the recovery room.

After surgical excision of bone spurs in your big toe’s joint, you will be transported to the recovery room, where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your foot will be elevated and your big toe immobilized in a splint when you wake up. The soft dressings covering your big toe help to hold it steady. After surgery, you will experience some pain and adequate pain medications will be prescribed for you. You may be given intravenous (IV), oral, or intramuscular pain medications as needed. Your surgeon will prescribe crutches, and you are usually instructed to keep weight off your big toe for one to two weeks. Your foot is placed into an open-toe sandal with a hard plastic bottom so your toes cannot bend. This post-surgery shoe is removable but should be worn as often as possible. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you can prepare to go home. You normally leave the hospital or clinic the same day after surgery, sometimes within four hours. If you experience a lot of pain, you may be admitted for an overnight stay after surgical repair of your peroneal tendons, but this rarely occurs. Make sure to have someone available to drive you home, as you will be unable to drive a car.

After surgical excision of bone spurs from your big toe, you may need to be on crutches for one to two weeks. Rest as much as possible with your foot elevated above the level of your heart. This helps blood drain away from your big toe and can control swelling. It is essential to keep weight off your foot for the first few days. Everyone heals at a different pace, so use your crutches to test how much weight you can bear without pain. As pain decreases, you will rely less on the crutches over the course of about two weeks. Always wear the stiff-soled sandal prescribed by your physician when you put any weight on the injured foot. Recovery is easier when you have someone around the house who can help with any physical chores. You will most likely return to your physician’s office within seven to ten days to have your stitches taken out. Follow up visits generally are scheduled for sometime around two weeks, six weeks, and then three months after surgery, depending on your specific problem and healing time. Most patients can return to normal shoe wear in three to four weeks. Physicians typically prescribe stiff shoe inserts that limit the bending in your big toe. You may visit on orthotist to have the inserts molded to fit your foot. When prescribed, these inserts should be worn in all your shoes, all the time. Taping your big toe can also help relieve pain. Your physician can help you find a trainer or physical therapist qualified to tape your toe. Your physician may suggest physical therapy that can be done at home, or refer you to a physical therapist to help strengthen your toe and lower leg muscles.

Recovering from turf toe surgery can often be done without formal physical therapy. In general, you should undergo a cardiovascular training program that progresses slowly while wearing the stiff-soled inserts prescribed by your physician during all physical activity. You may be able to return to sports and activities within six weeks. If the pain in your big toe flares up while training, you should visit your physician. You may want to visit a physical therapist to receive special treatments if you want to return to sports faster. Physical therapists can offer a combination of the following treatments after toe surgery:

   Heat treatments – Whirlpool baths and heating pads can help ease pain and warm up your tendons and muscles before exercise.

   Ultrasound – High-frequency energy waves pass through your toe and heat tissue deeper in the joint. Ultrasound may help promote blood flow through your big toe’s joint with your foot.

   Footwear – Physical therapists often can help you select shoes that have the appropriate support and shape for your foot.

   Taping – To further limit your big toe’s motion, physical therapists are trained to wrap tape around your toe and midfoot to help hold your toe steady. The taping is elaborate and physicians typically recommend you let a therapist tape your foot instead of trying to do it yourself.

   Range of motion – A physical therapist can stretch your toe in different directions and instruct you in the proper techniques for stretching at home.

   Strengthening – Special exercises for the smaller foot muscles include picking items off the floor with your toes, toe curls, and toe movement in a bucket of sand or rice.

   Gait training – Physical therapists can help you overcome a limp that may have been bothering you before surgery.

   Proprioceptive exercises – To restore balance, physical therapists have you train on a BAPS board, which is a board balanced atop a ball. You also may be asked to perform exercises while balancing on one leg.

 When your injured toe has the same strength as the other toe and your range of motion returns to normal, it is usually safe to return to sports and activities. A good test of toe strength is to run in figure-eight patterns. If your big toe continues to hurt when you cut in different directions, you should continue rehabilitation exercises.

Turf toe can become a chronic condition. People who suffer turf toe typically can return to action, but there is no cure. However, you usually can reduce the symptoms and play sports relatively symptom-free with proper protection. The longer you participate in competitive sports and activities on hard surfaces, the greater the chances are that you will reinjure your big toe. The most important preventive measure is to wear a stiff-soled shoe. In athletics, cleats seem to work better because they usually have a built-in plastic sole that is more rigid than a tennis shoe. Your physician may recommend avoiding activities on hard surfaces like artificial turf. Sports like soccer or baseball that are played on grass can be easier on your toes. Wear the stiff shoe inserts prescribed by your physician in all your shoes, whether you are going for a short walk or playing a soccer game. Once you have suffered turf toe, it is a good idea to use the stiff shoe inserts to limit bending in your big toe. Your major concern is to avoid arthritic deterioration of the cartilage where your big toe meets your foot. Continue to visit your physician if symptoms flare up. With proper medical care, most people can prevent reinjury and continue playing comfortably, at close to 100 percent, even though they may have an arthritic toe.