Sports Medicine
Sports Injury Prevention & Rehabilitation

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Sprained Toe

(Also known as Toe Sprain, Toe Injury)
What is a sprained toe?
A sprained toe is a relatively common condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of one or more toe joints.
Each of the toes (except the big toe) comprises of three small bones known as phalanges. The big toe only comprises of two phalanges. These small bones join to each other at the IP joints (Interphalangeal Joints) and to the bones of the mid foot (metatarsals) at the MTP joints (metatarsophalangeal joints). As a result, the big toe has two joints, whilst the remaining toes each have three joints. Each of these joints comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.
During certain movements of the toes, stretching or compression forces are placed on the toe joints. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a sprained toe and may affect one or more IP or MTP joints. The big toe is the most commonly affected, particularly at the MTP joint. This injury is known as a first metatarsophalangeal joint sprain.

Causes of a sprained toe

Sprained toes are relatively common in sports (particularly on non-slipping surfaces) and frequently occur due to a specific incident such as a hyperextension force (excessive backward bending of the toe) or a hyperflexion force (excessive forward bending of the toe). A sprained toe may also occur in contact sports (due to collision with another player), in kicking sports or in martial arts. Occasionally, a sprained toe will occur due to repetitive strain associated with overuse. This may be the case in patients who perform repetitive activities involving end of range movements of the toes.
Contributing factors to the development of this condition may include increased ankle flexibility, flat feet, poor foot biomechanics, foot instability, poor balance or the use of soft, flexible footwear. Sprained toes are commonly seen in sports such as gymnastics, athletics, and football.

Signs and symptoms of a sprained toe
Patients with a sprained toe often experience a sudden onset of toe pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the front, back or sides of the affected joint. Occasionally pain may be referred into the foot on the affected side. Symptoms are generally exacerbated with activities that place pressure on the affected joint such as walking (especially up hills or on uneven surfaces), running, kicking, jumping or standing on tip toes. It is also common for patients to experience pain on firmly touching the affected region. Swelling and bruising may also be present around the affected joint.

Diagnosis of a sprained toe
A thorough subjective and objective examination from a therapist is usually sufficient to diagnose a sprained toe and to determine the likely structures affected. An X-ray, however, should be performed in most cases to exclude a fracture. Further investigations such as MRI or CT scans may be required to confirm diagnosis and rule out other injuries.

Treatment for a sprained toe
Most patients with a sprained toe make a good recovery with appropriate therapy. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Crutches, protective padding, the use of stiff soled shoes or protective taping are often required for a period of time to protect the joint from further damage.
Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Treatment of a toe sprain in the first 48 – 72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following RICE which comprises of rest from aggravating activities (crutches are often required), regular icing, the use of a compression bandage and elevation of the affected limb. Anti-inflammatory medication may also be useful in this initial phase of injury and can hasten the healing process by reducing the pain and swelling associated with inflammation.
It is also important for patients with this condition to perform movement and strength exercises early in the rehabilitation process to prevent stiffness and weakness from developing and to ensure the toe and foot are functioning correctly. These exercises should generally be implemented as soon as pain allows and should be guided by the treating therapist. A gradual return to activity can occur once the patient is pain-free, provided symptoms do not increase. Taping or the use of orthotics may be required in this phase of rehabilitation.

Prognosis of a sprained toe
In cases of a minor to moderate toe sprain, return to sport or normal activity can usually occur in 2 – 6 weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Therapy for a sprained toe
Therapy for a sprained toe can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • the use of crutches
  • toe taping
  • ice or heat treatment
  • exercises to improve flexibility, balance and strength
  • education
  • footwear and activity modification advice
  • a gradual return to activity program

Other intervention for a sprained toe

Despite appropriate therapy management, a small percentage of patients with a sprained toe do not improve adequately and require other intervention. Some patients with severe injuries may also require other intervention to ensure an optimal outcome. When this occurs the treating therapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics may sometimes be indicated.