Document Type

Article

Publication Title

Cureus

Abstract

Turf toe, a traumatic sprain of the first metatarsophalangeal joint capsuloligamentous complex, is a clinically important cause of missed playing time in elite American football players. Low-grade injuries are commonly managed conservatively, whereas complete Grade 3 disruptions present a more complex therapeutic challenge because management depends on joint stability, sesamoid alignment, performance demands, and season timing. This systematic review evaluated return-to-play rates, recovery timelines, patient-reported outcomes, and post-recovery performance after operative and nonoperative management of turf toe injuries in collegiate and professional American football players. A systematic literature search of MEDLINE via PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed from database inception through January 2026 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Eligible studies included peer-reviewed cohorts or case series reporting return-to-play outcomes after turf toe injury in elite or near-elite American football athletes. Nine primary clinical studies representing 151 competitive athletes were included in the descriptive synthesis. Nonoperatively managed athletes demonstrated higher observed return-to-play rates and shorter recovery timelines than operatively managed athletes, but these comparisons were substantially limited by confounding by indication because surgically treated athletes generally represented more severe and mechanically unstable injury patterns. Operative repair restored joint alignment and produced favorable pain outcomes in selected unstable injuries but was associated with longer rehabilitation timelines and restricted terminal dorsiflexion. Stable low-grade and selected stable high-grade injuries may be appropriate for structured nonoperative management, while unstable Grade 3 injuries require careful imaging evaluation and may benefit from operative reconstruction to preserve long-term joint stability.

DOI

10.7759/cureus.118751

Publication Date

10-28-2026

Keywords

American football, elite athletes, metatarsophalangeal joint, nonoperative management, operative management, return to play, sports medicine, turf toe

ISSN

2168-8184

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