Turf toe can occur over time, so symptoms may be mild at first. A patient should be aware of pain or swelling associated with the big toe joint, also called the metatarsophalangeal (MTP) joint, which can prompt a proper diagnosis.

A clinical evaluation—medical history and physical examination—can detect turf toe. Imaging may also be used to verify the diagnosis, note additional injuries, and gauge the intensity of the MTP sprain. X-rays are routinely used by many doctors to check for bone fractures. A magnetic resonance imaging test (MRI scan) provides detailed images of non-bone structures, so this is the test used to confirm a turf toe diagnosis.

Clinical Evaluation: Medical History and Physical Evaluation

A person’s medical history begins the process of turf toe diagnosis. This includes an overall health assessment and discussion of symptoms.

During the physical evaluation, the medical doctor observes the big toe and looks for swelling and bruising. At the same time, the MTP joint is tested for range of motion: the physician watches for unstableness in the big toe when moving it in multiple directions. For a comparison, similar movements may be conducted on the opposite, healthy toe.


Imaging Testing

Imaging tests may also be used for turf toe diagnoses, in particular to gauge the extent of the injury and/or rule out other possible injuries.

  • X-rays may be requested to rule out bone-related issues, such as a fracture. It is recommended to have front and back (anteroposterior) and side (lateral) radiographs taken, along with central (axial) images of sesamoids, or small bones in the foot. A physician may take comparison X-rays of the opposite foot to ensure the sesamoids are correctly located, in a tendon under the MTP joint.
  • Magnetic resonance imaging (MRI) provides images of non-bone structures, such as the tissue, ligaments and tendon encompassing the MTP joint. This imaging is particularly beneficial for people with moderate to severe turf toe, grade 2 or grade 3 injuries, or in those with deformities found in X-rays.

While a clinical evaluation will indicate that the injury is likely turf toe, imaging allows a physician to assess damage to the MTP joint in greater detail.

Dr. Gary Stewart is an orthopedic surgeon specializing in general orthopedics, sports medicine, and total ankle replacement. He practices with Resurgens Orthopaedics and has served as the Chief of the Division of Foot and Ankle Surgery at the Atlanta Medical Center.