?Turf toe occurred in 60% of the offensive players, compared with 32% on defense. The most afflicted positions were offensive line, running back, tight end and wide receiver. "That can simply be explained by the fact that players at these positions are usually on the bottom of the pile," O'Brien says. The least likely sufferers were linebackers, the lucky ones who usually end up on the top of the heap.
?The incidence of turf toe was higher among players 27 years of age or older and those in professional football at least five seasons.
?Of the turf toe sufferers, 85% had hyperextension of the metatarsophalangeal joint. In most of these cases, the front part of the player's foot was planted on the field and the heel raised. Another player then fell across the back of the leg, forcing the toe joint beyond its normal range of motion. Some offensive linemen also reported they had been injured while pushing off from their stances; many running backs and wide receivers said they had been injured in the act of making sudden stops or quick cuts or after being tackled from behind.
?Players with good range of motion in their ankles were the most susceptible to the injury. "The more flexible the athlete is, the better able he is to get up on his toes [where a majority of the injuries occur]," O'Brien explains.
?A player's height, weight, length of second toe and shoe type were not factors that contributed to the incidence of turf toe.
O'Brien believes improperly fitting shoes can result in turf toe. "Most athletic shoes are fit in length, not width," he says. "Players with wide feet are forced to wear shoes that are too long for them. Thus the foot continues to slide forward after the player's shoe has been firmly planted on the ground, frequently resulting in traumatic injury to the joint."
Prevention of turf toe? Rodeo advises teams to keep a close watch on the shock-absorbency of their stadiums' artificial turf. "The newer synthetic fields approximate natural grass in impact characteristics," he says. "But five-year-old turf behaves similarly to the asphalt underneath. It doesn't give."
Barnes recommends placing spring-steel inner soles in a sturdy pair of shoes. "They will seem uncomfortable at first and will have the feel of standing on Formica," he says. "But you'll find that you get used to them."
O'Brien's suggestion is simple: Take the injury seriously. Perhaps, he says, trainers ought to routinely tape athletes' big toes prior to both games and practices—just as they currently tape athletes' ankles.
"Turf toe is here to stay," he says. "Increased recognition will lead to better treatment and, in the long run, will mean better performance."