How to Diagnose a Big Toe Sprain

You can sprain your big toe while playing sports, dancing or simply stubbing it. Known as “turf toe” among professional athletes who play on artificial turf, such a sprain can occur on all types of surfaces and in a wide variety of situations. The joint capsule at the base of your big toe, medically known as the first metatarsophalangeal joint, includes nine ligaments, four bones and three muscles with their tendons. Any or all of these can be damaged by trauma or repetitive injuries. Sprain is the term used for an injury to the joint capsule or ligaments, the tough bands of tissue that tie your bones together. It's caused by bending or jamming the big toe too far in any direction. Not surprisingly, active young people are at greatest risk for such injuries, but prolonged stress on these ligaments can eventually lead to similar problems. Although the signs and symptoms of a big toe sprain are fairly straightforward, the same changes can occur with muscle strains and bone fractures. Home treatment of mild sprains can be tried initially, but significant pain or bruising deserves medical evaluation for definitive diagnosis and to rule out a more serious injury.

Recognizing a Possible Sprain

Consider whether you might have suffered a recent injury to explain big toe pain or a sprain. A direct injury such as jamming your big toe while running or jumping, stubbing it or having it forcefully bent up or down too far should be pretty memorable. You might even have heard a popping noise at the time. Dancing, gymnastics or similar activities involving prolonged standing on your toes can also lead to a minor sprain.

Look for physical changes of your foot, especially in the big toe area. Pain when putting weight on the ball of your foot, pain over the joint or ligaments of the big toe, swelling, bruising, discoloration, stiffness or limited ability to move the toe are all indications of a possible sprain. The more obvious the changes, the more severe the injury is likely to be.

If you can remember the injury that caused your symptoms and the symptoms are relatively mild, you might consider trying watchful waiting and at-home treatment. Follow the general recommendations of the RICE approach to minor injuries: rest, ice, compression and elevation of the injured foot and toe. Non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin can help with pain and swelling if appropriate for you. If after two to three days, you don’t see any improvement, or the symptoms have worsened, it’s time to contact your health care provider.

Diagnosing a Sprain

Your health care provider will take a detailed history, including questions about possible injuries, recent changes in your activities and perhaps even the footwear you use. He will examine your foot and big toe for physical changes such as bruising and swelling, determine the areas of greatest pain and check flexibility and mobility of the joints. He'll also look for evidence of fracture or other possible causes of your pain.

X-rays of the injured toe are not always required to diagnose a sprain but can be used to help exclude a broken bone or other disease process. MRI or CT scans might rarely be performed if there are unusual findings or joint instability, since they show soft tissues, ligaments and joint capsules better than regular X-rays.

Sprains are classified, or graded, on a three-point scale of increasing severity. Grade I sprains involve only stretching or microscopic tearing of the ligaments and tenderness of the ball of the foot and usually resolve within two to three weeks 2. Grade II sprains have partial tearing of the ligaments, accompanying swelling and bruising in the area of the toe, and some decrease in joint motion. Severely or completely torn ligaments with significant joint damage, greater pain and bruising make up grade III sprains. Grade II and III sprains take longer to heal and in some cases may need casting or even surgery for proper healing.