Often, the injury occurs when someone or something falls on the back of the calf while that leg's knee and tips of the toes are touching the ground.

Additionally, athletic shoes with very flexible soles combined with cleats that "grab" the turf will cause overextension of the big toe.

It has also been observed in sports beyond American football, including soccer, baseball, basketball, rugby, volleyball, and tae kwon do.

[citation needed] Since the toes are necessary for proper push-off when accelerating, those sorts of athletic activities should be almost completely curtailed.

Additionally, wearing a shoe with a rigid sole (often a metal plate) and cushioned innersole will help minimize extension of the joint.