A broken toe is a common foot injury, yet it is one of the most neglected injuries in the entire body. Even though toes are very small, injuries to the toes can often be quite painful. The proximal phalanx is the toe bone that is closest to the metatarsals. Because it is the longest of the toe bones, it is the most likely to fracture. The fifth toe or the little toe is the most common toe fractured.
There are several common myths about a broken toe that prevent people from seeking medical attention promptly, such as:
“It can’t be broken, because I can move it.” – False. The truth is, often, you can walk with certain kinds of fractures, especially of the toe.
“You can’t do anything for a broken toe.” – False. A toe fracture needs prompt attention. X-rays will reveal the severity of the fracture and guide your treatment plan.
“If you have a foot or ankle injury (eg. broken toe), soak it in hot water immediately.” – False. Don’t use heat or hot water on any area you suspect is fractured, sprained, or dislocated. Heat promotes blood flow, causing more pain and swelling.
“The terms ‘fracture,’ ‘break,’ and ‘crack’ are all different.” False. All of those words are proper in describing a broken bone.
Causes: Broken toes usually result from trauma or direct injury to the foot or toe. Injuries such as hitting the toe or dropping a heavy object on a toe may cause a fractured or broken toe. Sometimes fractures can happen when a toe is bent up or down too far, or if the foot and toes are twisted. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture or the ground. A stress fracture is when the toe is injured from prolonged repetitive stress or movements.
Symptoms: After the injury, initially, you may experience severe pain, which will decrease in a few hours to a throbbing pain, along with swelling, or stiffness. Bruising of the skin around the toe may be noticeable. You may also notice crunching and grinding at the fracture site when you bend your toes or walk. You may experience numbness or loss of sensation on the fractured toe. Blood may collect underneath the toenail of the fractured toe or the toenail may be cut or torn. The shape of the toe may not look normal; it may look crooked, rotated inward or outward, or may be shorter than the other toes. It may be difficult to walk or wear shoes due to tightness and pain, especially if it’s the big toe that’s fractured.
You can help care for your broken toe at home to help decrease the pain and swelling, and help the fracture heal properly. Wear a hard-soled shoe to prevent motion in the fractured toe.
Rest: Avoid strenuous exercise, prolonged standing, or walking. Crutches or a special shoe may be required when walking to avoid putting weight on the fracture while it heals.
Ice: Put ice in a plastic bag, wrap in a towel to protect the skin and apply it to the injured area for 15 to 20 minutes every one to two hours for the first one to two days after the injury. Frozen peas or corn or other vegetable may be used in place of the ice.
Elevation: Swelling that occurs after the injury worsens the pain. To decrease the pain and swelling, keep the foot raised high above the level of the heart as much as possible by propping it up on some pillows, especially when sitting or sleeping.
It is best to see a podiatrist soon after any foot and ankle injury to ensure proper treatment and healing. The podiatrist will ask you how the injury occurred and will take an x-ray to see if and how the toe is broken. Proper treatment depends on the location and severity of the toe fracture. The fracture may need to be put back into place (reduced), splinted, casted or surgically corrected. If the x-rays reveal a simple, “not out of place” fracture, care by your podiatrist usually will produce rapid relief of pain and swelling. On the other hand, x-rays may identify a displaced or angulated fracture. In such cases, prompt realignment of the fracture is necessary to help prevent improper, incomplete, or delayed healing. Often, fractures do not show up on the initial x-ray, so it may be necessary to x-ray the foot a second time, seven to 10 days later.
If there is an open wound near the injured toe, a tetanus shot and antibiotics may also be necessary. In extremely rare cases, surgery may also be necessary to realign the toe. Usually, once the toe is realigned and the swelling is decreased, the pain will decrease significantly. Often, acetaminophen (Tylenol), ibuprofen (Motrin) or some other anti-inflammatory may be needed for pain control.
Buddy taping/splinting: If the toe fracture is small, or it is in one of the small toes, the podiatrist may only need to tape the injured toe to the one next to it for support as it heals. This is called buddy taping/splinting. It is recommended to place a small piece of cotton or gauze between the toes that will be taped together to prevent the skin between the toes from developing sores or blisters. Buddy splinting is applied by using two small pieces of cloth athletic tape or two small Velcro straps around both toes and can be changed daily. Your podiatrist may also recommend wearing a surgical or post-op (hard sole) shoe, which will further decrease motion in the toe that is fractured and help with healing. To further boost healing of the fracture, your podiatrist may recommend taking calcium and vitamin D supplements.
Broken toes usually take about six weeks to heal. Your podiatrist will repeat the x-rays periodically during this time to check how the bone is healing. Simple fractures usually heal well with no problems. However, a very bad fracture or a fracture that goes into a joint is at risk for developing arthritis, chronic pain, delayed healing, stiffness, and possibly even a deformity.
To help prevent an injury resulting in a broken toe, wear sturdy, supportive, well-fitting shoes.
• Wear the correct shoes for your particular sporting or recreational activity and change them when they are worn.
• Don’t walk barefoot on paved streets or sidewalks.
• Always wear hard-toed shoes when operating a lawn mower or other grass-cutting equipment. Wear “steel toe” boots and other safety equipment to protect your feet at work.
• Watch out for slippery floors at home and at work and clean up any obvious spills immediately. Pay attention to your surroundings, particularly when reaching into tall cabinets. It is common for canned goods to fall on the toe and fracture them.
• If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one’s way in the dark.
As with any foot and ankle injury, it is a good general rule to seek prompt treatment from your podiatrist.
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at email@example.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.