Turf toe like Ravens star Ray Lewis' can be serious

Ray Lewis, the Raven’s linebacker, has already missed two games and hasn’t been coming to practice because of a hurt toe.

While it may be hard to believe a toe injury could sideline such a player, doctors say “turf toe” can end careers.

It’s called turf toe because it’s associated with American football players who get hurt on artificial turf. Often a player has his foot planted and another player lands on the back of his calf, driving the toe to hyper-extend.

Dr. Rebecca Cerrato, a surgeon in the Institute for Foot and Ankle Reconstruction at Mercy Medical Center, said the degree of injury matters. Turf toe is basically a sprain of the ligaments that line the bottom of the big toe joint and it’s graded like any other sprain.

Grade 1 is when the ligaments are partially stretched and it’s considered mild. Grade 2 is a partial tear but not fully ruptured. Grade 3 is usually a complete rupture and maybe some breaks in the little bones in the area.

“The grade has a lot to do with how quickly they can come back,” said Cerrato, adding the injury is typically diagnosed with an X-ray.

Players with a grade 1 sprain can often return by the end of the game if they have no pain. The vast majority with grade 2 sprains are out for weeks as the swelling and pain subside. The toes need to be without pain and have a range of motion. They are often protected with tape and shoes that don’t allow the toe to lift up, Cerrato said.

Grade 3 injuries often need surgery. They are season-ending and can affect a career, said Cerrato, who has not treated Lewis and does not know the extent of his injury. Though, she said, since he’s been out two weeks already, it’s not likely a mild injury.

“The reason it’s debilitating is because an athlete needs to accelerate and change directions quickly, which requires pushing off of the toe,” she said. “That is definitely extremely difficult and painful.”

Athletes who try and play through the pain can more severely injure themselves and develop chronic long-standing problems with the joint, she said.

Athletes that want to avoid turf toe should avoid hard, inflexible artificial turf – which isn’t always an option. Cleats with stiff soles may also help.

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