Hyperextension of your toe can result in a sprained toe, causing pain and a limp with walking and running. You might also experience swelling, decreased range of motion and bruising. Initial treatment consists of rest, ice, compression and elevation; but once pain and swelling subside, you can do range-of-motion, strength and stability exercises. Consult your athletic trainer or physical therapist before doing exercises with a hyperextended toe.
Causes and Injuries
Hyperextension happens when your toe is extended or pulled back too far. Landing with your weight too far forward on your toes during running or jumping or a direct hit to your toes can lead to hyperextension. Hyperextension usually results in a sprain or tear of the ligaments that stabilize the joints in your toes. In severe cases, you may sustain a dislocation or fracture.
Hyperextension of the big toe and a sprain to the metatarsophalangeal joint is common among football and soccer players who play on artificial turf. That's why this injury is often referred to as "turf toe."
Range of Motion
Due to the swelling and immobilization of your toe, you may experience joint stiffness and loss of range of motion. While in a seated position, your physical therapist or you can hold your toe, gently flexing and extending it in the pain-free range of motion. This is called passive range of motion. As the pain subsides, you may move your toe without assistance by slowly flexing or curling your toes and then extending your toes, increasing your movements until you regain normal range of motion. Range of motion exercises can be performed up to seven days a week or as tolerated, if your physical therapist approves.
Strength and Stability
Strength exercises include marble or towel pickup, calf raises and toe walking. Marble pickup is performed in a seated position. Slowly pick up marbles from the floor with your toes, and place them in a bowl or cup. Towel pickup is also performed in a seated position, but instead a towel is placed underneath your foot. Slowly curl your toes to pick up the towel, place it back down, and repeat.
To regain stability, perform a single-leg balance for 30- to 60-second intervals. Progress in this order, while standing on one leg: close your eyes; stand on a wobble board or uneven surface; do a hip extension of the non weight-bearing leg and reach forward with your arms. Perform these exercises daily or as directed by your physical therapist.
Return to Play
Before you return to normal activities or your sport, perform functional exercises such as squatting, running, jumping and kicking. If these activities do not cause pain or additional symptoms, your physical therapist may discharge you from physical therapy. Taping your toe or putting stiff orthotics into your shoes may also be necessary to avoid further injury and pain when performing exercises or before participating in sports.
References
- New York University Langone Medical Center; Turf Toe; Laurie LaRusso, M.S.; 2010
- "Clinical Sports Medicine"; Rehabilitation of Ankle and Foot Injuries in Athletes; Lisa Chin, M.S., A.T.C, et al.; January 2010
- Sport Science Orthopaedic Clinic: Toe Sprain
- "Sports Medicine Patient Advisor": Turf Toe
- University of Wisconsin Sports Medicine Sports Link; Turf Toe; Jay Hanson
