The San Francisco 49ers aren’t the only team suffering from a toe injury to their quarterback – they just happen to be the less severe case.
After 49ers quarterback Brock Purdy missed the Week 2 game against the New Orleans Saints, and is expected to miss several thereafter, the Cincinnati Bengals received much more devastating news on Sunday.
Cincinnati Bengals quarterback Joe Burrow suffered a turf toe injury during their win over the Jacksonville Jaguars and will now be sidelined for a minimum of three months due to required surgery.
The back-to-back injuries to starting quarterbacks through the first two weeks of the NFL season shines a spotlight on one of the more serious yet trivially named injuries to football players. It also begs the question of scrutinizing artificial turf surfaces.
Turf toe sounds like a player stubbed their toe on the field and that it’s just jammed. It often has torn ligaments and should be viewed as a ligament injury. Much like high ankle sprains don’t actually have much to do with the ankle at all, turf toe has more to do with where the toe connects to the foot.
Clinically referred to as a metatarsophalangeal joint sprain, turf toe is a hyperextension of the big toe that occurs when the toe remains planted on the ground and the heel is lifted, according to the Cleveland Clinic.
There are three grades for a turf toe injury; the details around Purdy’s are less clear than Burrow’s. Burrow is said to have a Grade 3 injury, which is when the tissue in the toe is completely torn, and may have a joint dislocation.
That severity makes surgery an option, but lower grades mostly require rest and time to heal. Grade 1 injuries are when the tissue is stretched rather than torn and can be mostly resolved as soon as a week in some cases.
Grade 2 level is a partial tear with more limitations. With Shanahan referring to Purdy’s injury as a “turf toe variant,” the severity isn’t clear, but it likely falls somewhere between Grade 1 and Grade 2.
With Shanahan optimistically saying that “there is a chance” Purdy could play this Sunday against the Arizona Cardinals, it may be closer to Grade 1.
Notably, the Niners will return home for that matchup – where the playing surface very well might matter.
The Cleveland Clinic directly notes a correlation to the injury with NFL players on their website describing the injury:
“Turf toe is common among American football players because they frequently push off their toes into a sprint or make sudden movements while running on turf, which is less forgiving than grass,” the site reads.
The NFL Players Association has been pushing for a move to natural grass for years, releasing data that found a 28% increase rate in non-contact lower extremity injuries on artificial turf versus natural grass.
It was something that Nick Bosa directly pointed to as playing a factor in his 2020 ACL tear at MetLife Stadium on Synthetic Turf when speaking to Sports Illustrated's Albert Breer in 2022.
“I really think FieldTurf is a problem in the NFL,” Bosa told Breer. “And the turf I played on in New York was brand new. It was super soft, and apparently, they rolled a cement roller over it twice after the game because we had two ACLs and a bunch of other injuries on it.”
While artificial turf may be easier and cheaper to maintain, it frankly has no business being viewed under those “challenges” when it’s contributing to decimating injuries on the field.
Turf is a harder surface than grass, and that restricts flexibility for players to push off their feet. It does not absorb the necessary force, and that increases risk of injury to knees and feet/ankles.
It also doesn’t release cleats as easily as grass – that could also play a factor in the hyperextension of a turf toe injury when it gets stuck.
Burrow suffered his injury on synthetic turf with slit-film fibers. There have been calls by former NFLPA president JC Tretter to ban that specific type of turf. Purdy’s injury happened on Seattle’s FieldTurf Revolution 360. The only stadium that shares that type of turf is the New Orleans Saints.
San Francisco specifically chose grass for Levi Stadium, in part, to prevent injury.
Perhaps it’s more than overdue for the rest of the NFL to be required to do the same.