In this section Cypress Foot and Ankle expert Dr. Christopher Correa discusses toe fractures. Toe fractures are some of the most common types of fractures that come into podiatry clinic. While most toe fractures do not need any more treatment than rest, ice, and immobilization, some can be quite severe and may require a trip to the operating room.
Toe fractures are typically thought of in 2 categories: Small toes and big toes. The small toes are digits 2,3,4, and 5 leaving the 1st digit as the obvious “big toe”. The reason small toes and big toes are treated differently is because the large toe is more mechanically significant than the small toes. Often times when a large toe is broken the patient is unable to push off or even walk. Small toe fractures on the other hand (or foot) are generally better tolerated. Each small toe is comprised of 3 little bones call phalanges. Each phalanx is designed as distal, middle, or proximal (far, middle, near). The large toe differs in that it only has 2 large phalanges, distal and proximal. Toe injuries generally occur from direct impact injuries such as stubbing or crushing. Pain, swelling and bruising is usually intense and immediate typically leaving little doubt that “something bad just happened”.
Small Toe Fractures
Conservative treatment for lesser toe injuries includes stiff soled trauma shoe, buddy taping, non-steroidal anti-inflammatory drugs (Ibuprofen), and time. Even though small toe fractures are tolerated relatively well, they are notorious for swelling and being uncomfortable for a few months following injury. This is primarily because the patient continues to walk during the healing proves which leads to increased swelling and agitation. Often times small toe fractures do not require surgical correction unless the two fragments are so far separated from one another that they have no hope of healing. In these cases, the broken bones are either relocated and pinned in placed or partially removed if the damage is severe enough.
Big Toe Fractures
Conservative treatment of large toe injuries differs quite significantly from small toe fractures. As mentioned before during toe off (push off) during the walking cycle the big toe it makes it more difficult and painful to walk with a broken big toe. Due to this buddy taping and a trauma shoe is not adequate to immobilize the toe an instead require at minimum a walking boot and in severe cases a period of non-weight bearing. As with lesser toe fractures, displacement of the fracture fragments and fractures that disrupt the joint require surgical reduction and fixation.
If you suspect you fractured one or more toes it is important to schedule an appointment with a specialist and have an X ray performed to determine the extent of injury. Toe injuries with an underlying fracture where the nail is lifted up or blood forms under the nail could mean that the soft tissue envelope is disrupted, and the bone is exposed. This condition is called an open fracture and can occur because the bone passes very close to the skin under the nail. If this think covering is disrupted a bone infection could result if not treated with an antibiotic promptly. Early treatment with irrigation and debridment – often times in the office have a good prognosis. If you believe you are suffering from a toe fracture DON’T WAIT, make an appointment with the experts at Select Foot and Ankle Specialists today and take the first step towards recovery!
