Turf toe and football: Why it can sideline players in a flash.

We rarely give our big toe much thought. But every time we run, jump or pivot, it takes on our entire body weight in that split-second.

A big toe hyperextending too far is known as turf toe, an injury that has already sidelined NFL quarterbacks Brock Purdy and Joe Burrow this season. Burrow is slated for surgery and three months of recovery.

Turf toe is not a broken toe, but a very painful sprain. It happens when the ligament known as the plantar plate – which connects the big toe to the ball of the foot – stretches or tears while pushing off from a hard playing surface like artificial turf. It’s most common in football, soccer, basketball and dance.

While turf toe mostly affects adult athletes, parents should not push kids to play through what could be a serious injury, said orthopedic surgeon Dr. John Marcel Jr. of Novant Health Orthopedics & Sports Medicine - Cotswold in Charlotte. See news about weekend hours below.

“If you or your child are in pain, speak up and come get evaluated,” Marcel said. “An X-ray can rule out fractures, and most of the time turf toe can be managed without surgery. Our priority is to get patients back to playing as soon as possible.”

Here, Marcel explains the impact of turf toe on athletes of all ages.

How does turf toe happen?

It’s a tearing of the thick tissue that stabilizes the big toe. When the toe gets forced upward rapidly and forcibly, that structure can tear and cause immediate pain, swelling, bruising and difficulty walking.

Does turf toe affect only athletes?

Mostly, but it can happen to anyone. It’s generally not an injury you’d get while walking down the street but typically associated with athletic activity.

Stretching and warmup exercises are important but unlikely to prevent an injury like this. Unfortunately, it can happen no matter how warmed-up you are. The only thing you can do to protect yourself is to wear a supportive cleat with a stiff sole.

What red flags should parents watch for when toe pain turns out to be more than a bruise?

Kids and teens tend to downplay injuries because they want to keep playing. So if your child is bruised, swollen or limping, that means something is wrong and it’s time to bring them in for an X-ray and evaluation.

How often is surgery necessary?

Surgery for turf toe is rare and depends on the extent and severity of the injury. Generally speaking, we only do surgery to address instability or deformity of the toe joint. Candidates for surgery generally go home the same day but have to use crutches or a knee scooter to get around for at least a month or six weeks.

Most of the time sprains or even partial tears get better with time and rest. But what you don't want is to have a complete rupture and put off treatment. Addressing the injury right away leads to better outcomes.