Etiology
Bowers and Martin coined the term turf toe to acknowledge the predisposing factor of artificial synthetic surfaces on hallux metatarsophalangeal (MTP) joint sprains.[6] They found that injuries occurred most frequently in athletes playing on artificial turf who wore flexible, soccer-style shoes. More recently data collected from The National Collegiate Athletic Association Injury Surveillance System has been useful in identifying key susceptibility factors. Injuries seem more likely to occur in games as opposed to practices and with artificial as opposed to natural grass. Furthermore, a greater percentage of injuries appear to occur in running backs and quarterbacks. More detail regarding causative factors is located below.[21]
Footwear - Throughout the past several decades, football shoes have evolved from the traditional 7-cleat shoe containing a metal plate in the sole designed for grass surfaces to a more flexible, soccer-style shoe designed for grass surfaces and, finally, to a shoe designed for artificial turf. These changes in shoe type have allowed increased speed at the expense of stability. The absence of a stiff sole places the forefoot, and specifically the MTP joints, at much greater risk of sustaining stress-type injuries. Athletes wearing flexible turf shoes are much more prone to injury than are those wearing shoes containing a stiff forefoot.
Synthetic surfaces - Artificial grass contains a higher coefficient of friction and tends to lose some of its resiliency and shock absorbency over time. The combination of increased surface friction and a hard undersurface is believed to play a major role in the natural history of the injury. A higher coefficient of friction places the forefoot at greater risk of becoming fixed to the playing surface. Thus, the forefoot becomes more prone to an external force that places the hallux MTP joint in a position of extreme dorsiflexion.
Ankle range of motion (ROM) - The risk of turf toe appears to be related to the range of ankle motion in the injured person. A greater degree of ankle dorsiflexion has been correlated with the risk of hyperextension to the first MTP joint.
Miscellaneous - Other factors have been postulated to play a role in turf toe. These include a player's position, weight, and years of participation, as well as hallux interphalangeal degenerative joint disease, pes planus, and prior injury. For the most part, study results regarding these factors are largely inconclusive. Another point worth mentioning, however, is that a number of groups have, after researching the question, found no correlation between MTP joint ROM and the associated risk of turf toe.