SEATED ON A cart. Donte Jackson, who is teary-eyed, heads back to Carolina's locker room to practice what he will say to his big toe. In Week 3, 2020, Panthers cornerback Donte Jackson suffered a debilitating injury to his turf toe while trying to defend a deep ball from the Chargers. Jackson was taken off the field in Week 5 against Atlanta by a numbing, constant pain and aggravation. This is all you need to know about this horrible injury.
Jackson said, "This thing, its mind is all yours, it tricks you," and is now fully recovered. He is currently the Panthers' No. 2 tackler. 2-ranked defense. It takes so much effort to get back, and it's not easy to see how the toe is doing. What's the toe? It's the toe. You think you are good to go, but one jump, one false move and one push out from a break will send you back to square 1, and the whole process is over.
Jackson was in rehab for 14 days. Jackson tried out different tapes, icing methods and custom insoles to make sure he was ready for the Panthers divisional opponents. All week, everything felt great. The warm-ups were flawless. Jackson let out a sigh of relief after kickoff. He felt like he had survived the worst rites in his NFL career and was back to his 4.3 self.
The turf toe returned with a vengeance after Jackson made a simple diagonal cut during the first defensive snap. Jackson kept his composure until he reached the locker area. He then broke down and wept. Jackson was caught cursing, pleading, and finally apologizing for his actions to his big toe.
It is a meaculpa that this, at least in the NFL, has been long overdue.
Jackson stated, "You don't think about your big foot or how important it is until you have to use it."
Patrick Mahomes was forced to withdraw from a playoff divisional game against the Browns because of a concussion. Although he was cleared to return to play the next week, his persistent turf toe pain grew as the playoffs progressed. Jamie Squire/Getty Images
LIKE IT WAS with Super Bowl LV, Patrick Mahomes, the 2021 NFL season will be decided by a bone as small as a pea. This injury is often mistaken for a fungus.
After the Chiefs' second touchdown drive against Cleveland Browns, Mahomes was seen limping to the tent and grimacing, grabbing his left big toe. According to Dr. Robert Anderson, it was the sign of turftoe, a painful, debilitating condition that affects 50 skill and speed players annually and has ended the careers some of the most talented and hardiest players in NFL history. This is not an average. Have a look at Deion Sanders, HOFer, and his mangled left big foot sometime. But not before you eat. Or read the headline from 1985 about Jack Lambert, the Steel Curtain's toothless HOF linebacker: "Toe Ends Lambert’s 11-year reign as Steelers LB."
"I cared for a man a few years back and the headline was Big Toe Big Problem?" The message was "Why is a strong, big football player suffering from a toe injury?" Anderson has seen nearly 500 NFL players (including Mahomes) with toe, foot, and ankle issues since opening the state-of-the art facility in Green Bay, Wisconsin in 2017. Anderson says that although it is inappropriate to call it "sexy", players will say, "Oh, my ACL burst," and then they'll talk about their big foot. People are shocked.
"People still view turf toe as a simple sprain of a big toe. What we have learned is that this should be treated as any other ligament injury in the body.
The Chiefs will.
Mahomes suffered a concussion in the third quarter of last year's playoffs. His brain was sufficiently healthy to beat the Buffalo Bills the next week, but the nagging turf injury to his foot only got worse, and the pain intensified during the Super Bowl.
Jordan Reed, an ex-Pro Bowl tight end, suffered from turf toe in his feet before retiring in April. He compared the constant, crippling pain with a toothache at the bottom of the foot. He says that the mental anguish, fatigue and pain are worse than the pain.
Jordan, who was a Washington player for six seasons, said that every time you step, it sends that shock through your entire body. This injury is very detrimental to mental health. It limits the potential for men to be their best selves. Although the pain is manageable, it was the fact that I wasn’t the same athlete and would never again be that same athlete that made it really difficult for me. This is why the big toe matters. It will make your life easier and more explosive.
Anderson saw his first victim of turf toe, Tommy Hudson, before Week 2 of 2021 training camp was even over. After seeing what it did to Steve McNair, the Titans take turf toe seriously. McNair was a former MVP quarterback who is well-known for his extreme pain tolerance. He suffered two seasons of turf tee agony and finally had to have surgery. Anderson, the first-year tight end, was able to return to practice in Week 2. McNair prepared for Super Bowl XXXIV in a protective boot, and was actually hobbling through practice.
Bad toes already hinder the Lions Pro Bowl center Frank Ragnow and Josh Jacobs, Raiders runningback Josh Jacobs, and Bucs wideout Scotty Mills in 2021. Turf toe has hampered star players like A.J. Green, Julio Jones, and Davante Adam, along with running backs James Conner and Phillip Lindsay, have been hampered by turf toe in the past few years. The 2020 season saw rookie Gibson, who was the leader in Washington's rush, break his toe against the Steelers in December. Gibson ran for 209 yards and scored four touchdowns in the two games prior to turf toe. The two games that followed? He ran for 136 yards with zero touchdowns. Gibson called the injury "something minor," but Ron Rivera, his coach, understood how serious it was. Rivera stated, "It's concerning." Rivera said, "It is complicated for a runningback because he has to plant, cut and turn. He runs with his power and energy from the big toe.
Gibson is considered fortunate in the NFL locker room because he had to endure the pain of turf toe for the last month of the season. The Giants Sterling Shepard smashed his toe in Week 2, and the turf toe continued to ache for three and a quarter months. Shepard stated that he didn't know anything about turf toe at the time. Anyone who has it knows it is not something to be played with. It's difficult to do your job if you don't have your big foot, especially if you are a skilled position guy. This is one of the most frustrating injuries I have ever suffered.
It was the same for Mahomes. Even with weeks of treatment, a carbon-fiber orthotic was placed in Mahomes' left cleat to reduce the extension of his famed phalanx. However, even after all that, his turf toe rendered him a shell of himself in a 31-9 defeat to the Bucs in Super Bowl LV. While the Chiefs' defense and offensive line were both important factors, Mahomes (0 touchdowns, 2 interceptions, and a 52.3 passer rating), was still unable to move against the rush or drive with his usual speed and wizardry. This was in large part due to the troublesome toe, which was more painful than anyone realized.
Since opening the state-of-the art facility in Green Bay in 2017, Dr. Robert Anderson treated almost 500 NFL players with toe, foot, and ankle issues. Bellin Health
Although it is caused by hyperextension of the big foot, the injury has little to do the toe. It's called turf toe. Dorsiflexion hyperextension of the hallux metatarsophalangeal joints, specifically the flexor longus tendon, and the sesamoid complex results in a plantar capsuleoligamentous strain. All that terminology refers to is a strain of the sesamoid bone, tendons, and ligament complex under the big-toe's large, knuckle joint or the ball. These tiny sesamoid bones can make a huge difference in your career and help you win the Super Bowl. Turf toe, like all ligament and tendon injuries, can be classified into three to four weeks of recovery. A mild strain will heal in this time frame, while a severe rupture of the joint requires surgery before it becomes arthritic. This could lead to hallux rigidus, which can cause career-threatening or worsening problems. Sanders claims that his deformed digit prevented him from participating in "Dancing with the Stars."
Although Mahomes might have insisted for weeks that his toe was fine, he flew to Green Bay just days after the Super Bowl to undergo surgery by Dr. Anderson. Although he has made a complete recovery, he still gave us the most compelling evidence that after 40 years of being a professional in turf toe, it might be time to take this seriously.
It can happen on any surface. However, it was most common in turf toe that began with AstroTurf's introduction in the 1970s. The NFL took a decade to fully understand what was going on. Anderson performed the first surgery to repair the tendon controlling the big toe on Sterling Sharpe, a Packers All-Pro tightener. Sharpe and Mahomes are able to load eight times their bodies (1,840 lbs for Mahomes) onto one big toe when they accelerate, cut or stop, especially in an explosive fashion. The complex biomechanics that govern this tiny joint fail spectacularly when the toe gets caught in the turf.
Three flexor tendon connect the arch of your foot to the phalanx joint. They are responsible for creating tension and spring in the big toe. The medial (inside), flexor tendon covers the medial sesamoid bones, while the lateral (outside), flexor tendon covers the lateral sesamoid bones. The sesamoids are the "ball" in your feet. These tiny, pea-sized bones glide along the undersides of the toe joint and act as a pad or lever to increase efficiency. Sesamoid bones and two minor tendons provide stability for the joint, while keeping the large, important flexor hallucis lungus (FHL), tendon in the proper alignment.
Coach Dan Campbell said that Lions center Frank Ragnow was warming up in training camp and was placed on injured reserve for several weeks. He had "a version of turftoe" during the process. AP Photo/Paul Sancya
The FHL is the biggie. The FHL runs between the sesamoids and the tip of your big toe. It is the last link in a kinetic chain which creates and directs all the power and explosiveness of a football player or sprinter. The FHL must work overtime to provide stability and tension to the joint for athletes who strain their flexor tendon or sesamoids. The big toe of an athlete is in a lot of pain due to diminished tautness and inflammation. Without any support, they can't move their foot in any way.
Anderson said, "It's almost like a windshield wiper moving one direction and not returning." Think of it like Mahomes trying throw a three-finger deep ball with his index finger, but trying to scramble or plant turf toe in Super Bowl.
Mahomes was able to avoid many of the lingering issues that are associated with turf-toe, as the injury happened near the end. First, the amount of trauma that Mahomes sustained in such a narrow space is too much for the swelling to escape, leading to intense discomfort. Turf toe pain is often too severe for Toradol to help. Pregame Marcaine shots are not recommended for turf toe because they can cause pain and numbness throughout the foot.
This is the reason why NFL players hate and loathe their turf toe more than anything. They don't even want to talk about it. Mahomes politely declined to answer the question. Phillip Lindsay, a Texan running back, scheduled and cancelled three interviews on the topic. Even Deion rejected the request before the file had been downloaded fully.
Reed, a rookie in the NFL, walked into the Washington training area and saw a veteran picking up marbles from the floor using his toes to repair turf toe. It was funny, but the poor man was sweating bullets, his jaw was closed, and his face was twisting from pain.
"What are your thoughts?" Reed laughed.
The back responded, "Man, I got turf foot." This is a suck. Trust me, don't-get-this.
Reed now says, "I was like, ‘damn!’" "My feet are everything. That was the first thing that I thought. My feet are the reason I'm here. If anything happens to my feet, it's over.
Jack Lambert's victory over Preston Pearson, the Dallas running back, in Super Bowl XIII 1979, is still one of the most iconic figures of the NFL. Turf toe was all that made him look mortal. Malcolm Emmons/USA TODAY Sport
Aside from being forced to play the most bizarre game of marbles ever created, mild and moderate cases are caused by turf toe. Players find themselves in a no-man's land where they can be hurt enough to affect their performance but not so severely that they have to stop playing. Their nerves have become fried by the end of the season. Their Madden rating has dropped and their sesamoid complex (Anderson took the photos) looks like raw hamburger. Reed said that chronic turf toe has "sold me into depression. It takes away your confidence, who you are, and that was disastrous for my career." Reed decided to try acupuncture instead of relying on opioids for his constant pain. He also began to practice physical therapy, acupuncture and cannabis. This led to him becoming an investor and advocate in the marijuana industry.
Players find preventative tapping too restrictive. A.J. Green blames artificial turf for his problems. Anderson however, says that turf toe can happen on any surface. Mahomes' first signature shoe was released before the season began. It features his logo and is available in neon green. These shoes are cool. But Anderson claims that the $100 billion dollar sports shoe industry would be better off if it could develop a cleat which doesn't hyperextend beyond 50 degrees, or increases rigidity as the foot expands.
The only thing that men who endure the pain of turf-toe are rewarded for is an extra laundry list of problems caused by overcompensating to their big toe. Reed injured his right hamstring after he got turf toe on his left foot. Reed claims that the loss of speed and elusiveness due to turf toe made him more vulnerable to larger hits. This led to multiple concussions which forced him to retire. Lindsay suffered a turf toe injury last season in Denver. He also had knee and hip problems. He signed a one year deal with Houston instead of receiving a large payday from the Broncos. After recovering from turf toe injuries in camp, Hudson was then injured his ankle. Jacobs' turf injury was also sustained after he fell on his ankle. In the playoffs, Mahomes also suffered turf toe in quarter two and concussions in the third. He was dragged from behind.
Even the most tough players can feel the pain of the big toe.
Lambert, the Steelers' former snarling defensive linebacker, is still a staple on any NFL all-time list. This includes the 75th Anniversary All Time Team. Yet, his only real strength was his turf toe.
Lambert ripped his toe off on the second play in 1984's Three Rivers Stadium. The unforgiving playing surface of Three Rivers Stadium was nothing more than a green carpet over cement. Lambert, who was "just a foot," ignored the pleas of Steelers owner Art Rooney Sr. to heal the injury and was placed on injured reserve.
He said that his toe was still hurting and couldn't push it off ten months later, in July 1985. Joe Gordon, an ex-Staters team spokesperson, said that the injury was "totally debilitating", that he could not run without pain, nor could he run very fast. It was sad because he was a great player, and he had at most two to three more years of good years.
A final footnote about turf toe: Lambert did not retire completely from sports for another ten years. Lambert still needed a physical outlet and turned to hockey to get it. The skates kept his toe immobilized and protected, and his front teeth were already lost. Lambert eventually became good enough to play in regular pickup hockey against Pittsburgh Penguins players.
Lambert admitted that if he had it all over again, he may have given up on football.
Hockey is not a game of turf toe.
