Turf Toe Exercises for Injury Prevention

Turf toe is a sprain of the metatarsophalangeal joint (MTP joint) caused by hyperextension of the big toe. It is most common among high-impact sports with soccer players, rugby players, and football players and can lead to chronic toe or foot pain. If you’ve developed turf toe, exercises will vary with each stage of the recovery process; which typically starts with a period of immobilization for the joint of the big toe. As tissues heal and symptoms decrease, you will focus on increasing range of motion, strength, and lastly restoring power. Check out exercises for each stage of recovery below.

Early Recovery

The primary goal immediately after a turf toe injury is to allow proper rest while minimizing loss of function. This means managing symptoms at home like swelling and pain. (/blogs/resources/treating-turf-toe) Additionally, performing these gentle exercises can help promote circulation and keep the toes limber and strong.

1. Toe Scrunches

Also great for the plantar fascia, this exercise works the muscles in the bottom of the toes and feet. Thus, it’s important to start gently and only move within a range that doesn’t aggravate your pain. With time, the range and ease of coordination will improve.

• Sit in a chair with a hand towel flat on the floor
• Place your foot flat in the center of the towel
• Lift your toes up toward the ceiling
• Then, reach your toes as far forward as possible before curling the toes under against the towel
• Scrunch the towel under your foot and toward your heels
• Keep your heels on the ground throughout except for when adjusting the towel
• Repeat for 10-15 repetitions for 2-3 sets on each foot

2. Toe Flexion and Extension

This gentle toe exercise keeps your toes moving to minimize unnecessary stiffness. It is also a very low-impact way to keep the muscles in the feet and toes working without risk of injury. As always, don’t force the range if you experience pain.

• Long sit on the floor or your bed with the legs out straight in front of you
• Keep the ankle in a neutral position with your heels resting on the ground
• First, bend the toes and bring them as close to the ball of your foot as possible
• Then, reverse directions and bring your toes back toward your shins
• Move slowly back and forth between these two positions
• Repeat for 10-15 repetitions for 2-3 sets total

3. Foot Doming

Keeping the foot strong, particularly the arch, is important for preserving foot function. This will help immensely as you transition to more dynamic exercises and power moves too.

• Sit in a chair with your foot resting flat on the ground
• You will be focusing on increasing the arch height of your foot between the ball of your foot and heel
• Keep the entire foot firmly on the ground as you gently lift the arch by pushing down into the ball of the foot and gently shifting your ankle outward
• Make sure your toes do not curl under during the process
• Hold for up to 5 seconds
• Repeat for 10 repetitions for 2-3 sets total on each foot

Mobility Recovery

A foot injury of any type can leave your ankle, toes, and entire foot feeling stiff. When mobility is limited, it affects the dynamic of the foot with everyday movement and sports. Ultimately, this can make the entire lower chain (aka the legs) more prone to injury.

1. Big Toe Towel Extension Stretch

This stretch should be initiated with caution since you will be directly stretching the injured tissues in the bottom of the big toe. However, gentle stretching will be beneficial for keeping the tissue supple and adequately mobile.

• Sit in a chair with a hand towel placed flat on the floor
• Place your foot flat in the center of the towel
• Grab the front corners of the towel with your hands
• Lift the edges up and toward your shins to bend the toes back
• Keep the ball of the foot and heels firmly on the ground throughout
• Do not force the stretch
• Hold for 30+ seconds for 2-3 sets total

2. Ankle and Toe Combination Move

This combination takes an extra moment to coordinate. However, once you have it figured out it is a great stretch for the tendons of the toe flexors and extensors to keep the tendons moving smoothly and reduce any stiffness in the foot. 

• Sit with your legs out in front of you or in a chair with your leg propped on a stool, foam roller, pillow, or towel roll so that the entire foot and ankle can move uninhibited 
• Curl the toes down toward the ball of the foot as you dorsiflex the ankle back toward your shin
• Hold for 5 seconds
• Next, reverse directions by extending the toes back toward the shins as you point the entire foot downward
• Hold again for 5 seconds
• Repeat for 10-15 repetitions on each foot for 2-3 sets  

3. Standing Calf Stretch

A standard calf stretch can help keep the tissues of the ankle and foot balanced for daily activities. Plus, a stiff calf can aggravate a toe injury without addressing it properly.

• Stand facing the wall or a chair for balance
• Step the leg you want stretch back into a lunge position
• Make sure the back toes are pointing straight forward with the foot flat on the ground
• Bend the front knee as you shift your weight forward
• Continue shiting until you feel a stretch in the back calf and hold, do not let your heel lift off the ground
• Hold for 30+ seconds for 2-3 sets

Strength Recovery

As your toe begins to heal, your focus will shift from stretching to more dynamic foot-specific strengthening. These exercises are designed to prepare your foot for higher-level weight-bearing activities.

1. Toe Flexion with Resistance Band

Grab a light resistance band to get started with this one. You can always progress your resistance with time with a heavier band. This exercise will work the muscles directly in the bottom of the foot so proceed with caution initially.

• Sit on the floor or in a chair
• Wrap the resistance band around the ball of your foot and toes
• Hold each end of the strap and keep the resistance at a comfortable level
• Push against the resistance as you curl your toes under
• Hold for 2-3 seconds 
• Repeat for 10-15 repetitions for 2-3 sets

2. Toe Spreaders

This exercise helps build dynamic strength in the foot. Spreading the toes is easier for some people than others, so simply focus on doing your best even if the movement is minimal.

• Sit comfortably in a chair
• Rest one foot so that the toes are free
• Spread the toes as far apart as possible, just as you would with your fingers
• Hold for 1-2 seconds 
• Repeat for 10-15 repetitions for 2-3 sets

There are many other great toe coordination exercises that you can try too, such as big toe extension or abduction. 

3. Heel Raises

Transitioning to heels raises is an important last step before getting back to more sport-specific moves. This is because you need the stability and coordination to be able to lift your heels and push through the ball of your foot, just like you do with walking, running, jumping, and more. 

• Stand with the feet approximately hip-width apart
• If needed, you can stand near a wall or chair for balance- your ankle may feel wobbly due to your injury and throw off your balance
• Lift both your heels off the ground simultaneously as you shift your weight into the forefoot
• Continue lifting as high as you can while maintaining ankle stability with minimal pain
• Keep your posture upright without leaning forward or bending at the hips
• Focus on keeping the return movement slow and controlled
• Repeat for 10-15 repetitions for 2-3 sets total 

Power Recovery

The last step in recovery is preparing your foot for the reality of your sport. If you skip this last step, it puts you at a significantly higher risk for reinjury. Thus, it’s important to imitate and practice moves that will provide excellent control and carry over for your actual sport.

1. Single-Leg Calf Raise Off a Step

Every time we take a step, whether running or walking, we are essentially doing a single leg calf raise. Being able to properly coordinate this will provide your lower body the power it needs to propel itself forward.

• Start by stepping up on a step with both feet, preferably near a wall or bar for balance
• Then, bring the ball of the foot you will be working to the edge of the step so that the heel is hanging off the back of the step
• Shift all your weight into the foot you will be working
• Keep your opposite foot clear as you let the heel drop toward the floor
• Go as far as is comfortable before reversing the direction, bringing the heel up toward the ceiling as high as possible by pushing through your midfoot
• Hold for 1-2 seconds at the top before returning to the starting position
• Repeat for 10-15 repetitions for 2-3 sets on each leg
• You can progress the level of hold or add weight to make it harder with time

2. Tip-Toe Walking

Being able to push off and accept weight through the midfoot is an essential part of being able to accommodate the stresses of sports. This is of particular importance with activities that require pivoting and sudden changes in direction on artificial turf.

• Stand with your feet hip-width apart
• Lift your heels off the ground as if to do a calf raise, ensuring that you’re lifting them as high as possible
• With good ankle stability, start walking forward 10 steps
• Then, turn around 180 degrees and repeat the 10 steps back to your starting place
• Repeat for 3-4 sets total
• You can vary the position and level of difficulty by adding a bend in the knees, adding a small hop, increasing the speed, and more
• Make sure to keep an optimal upright posture and keep the heels as high as possible to boost strength

3. Lunges

A lunge is a very functional movement that requires adequate big toe range of motion, strength, and coordination. Start with a basic lunge and then build to more dynamic foot movement from there.

• Stand with the feet hip-width apart
• Take one large step forward with one foot
• Keep the back knee relatively straight as you bend the front knee and shift the entire body straight down toward the floor
• Make sure the front knee stays behind and aligned with the toes
• Go as low as you can and hold for 2-3 seconds before returning to the starting position
• Repeat 10-15 times for 2-3 sets on each leg
• You can focus on one leg at a time or alternate legs

When you’re ready, hold your lunge at the bottom and try lifting your front heel up and down from the ground. 

Tips for Rehabbing Turf Toe

If you allow proper healing time and follow the steps recommended by your orthopedic doctor or doctor of physical therapy (DPT), turf toe rehab is pretty straightforward. To expedite your recovery, keep these simple tips in mind.

• Never force a stretch or movement that feels unstable or poorly controlled to protect your foot’s ligaments and the big toe joint capsule

• Use other treatment modalities to manage your symptoms such as ice, heat, and soft-tissue foot massage as needed for pain relief

  More on Turf Toe Treatments

• Assess the quality of your shoes and consider additional support from shoe inserts, orthotics, or foot taping techniques

  How to Tape for Turf Toe

• Always follow the guidelines for return to your sport set by your doctor and/or physical therapist for your toe joint sprain

• Make sure you don’t skip the last step of recovery with sport-specific moves to reduce the risk of further injury and adequately prepare your foot to prepare for athletic activity 

Consult Your Physical Therapist

If you’re ever feeling unsure about what treatment program is best for you, it’s always best to chat with your physical therapist. They can help give you clarity and personalized recommendations for optimal healing potential. Particularly, if your symptoms suddenly get worse or aren’t getting better over the course of a few weeks with treatment, make sure to bring this to your doctor or physical therapist’s attention immediately for further medical advice and appropriate adjustments to your toe injury program.

Sources:

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-turf-toe

https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments#1

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