Toe Injury

TOE INJURY

DEFINITION

  • Injury the skin or nail of the toe.
  • Injury to a bone, muscle, joint or ligament of the toe.

Types of Injuries

  • Abrasions or Scrapes: An area of superficial skin that has been scraped off. Commonly occurs on the knuckles.
  • Bruises: Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.
  • Cuts and Scratches: Superficial cuts (scratches) only extend partially through the skin and rarely become infected.  Deep cuts (lacerations) go through the skin (dermis).
  • Fractures (broken bones)
  • Dislocations (bone out of joint)
  • Jammed or Stubbed Toe: The end of a straightened toe receives a blow (usually from kicking something). The ligaments and tendons of the toe are stretched and torn.
  • Smashed or Crushed Toe: This injury most often results from a heavy object falling on the toe. Usually the end of the toe receives a few cuts, a blood blister or a bruise. Sometimes the nail is damaged. A fracture of the bones inside the toe can occasionally occur.
  • Subungual Hematoma (blood under toenail): This medical term is applied when a blood clot forms under the toenail. It is caused by a crush injury to the tip of the toe. Some are only mildly painful  and blood is typically under < 50% of nailbed. Others can be severely painful and throbbing, and these may need the pressure released to relieve pain. The pressure can be released by putting a small hole through the nail.  With larger subungual hematomas, the toenail will usually fall off. A new nail will grow back in 6 to 12 weeks.
  • Torn Nail: From catching it on something.

When are Stitches Needed?

  • Any cut that is split open or gaping probably needs sutures (stitches). Cuts longer than 1/2 inch usually need sutures.
  • A physician should evaluate any open wound that may need sutures regardless of the time that has passed since the initial injury.

FIRST AID Advice for Bleeding:

  • Apply direct pressure to the entire wound with a clean cloth

See More Appropriate Topic (instead of this one) If

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WHEN TO CALL YOUR DOCTOR

Call 911 now (you may need an ambulance) if:

  • Major bleeding (actively bleeding or spurting) that can't be stopped
  • Toe has been partially or completely amputated
  • Note: For bleeding, see First Aid

Call your doctor now (night or day) if:

  • You think you have a serious injury
  • Injury looks like a dislocated joint (crooked or deformed)
  • Bleeding that hasn't stopped after 10 minutes of direct pressure
  • Cut or scrape is very deep (e.g. can see bone or tendons)
  • Skin is split open or gaping and may need stitches
  • Blood present under a nail is causing severe pain
  • Toenail is torn from a crush injury or cut
  • Dirt or grime in the wound is not removed after 15 minutes of scrubbing
  • Toenail is completely torn off
  • Base of toenail has popped out from under skin fold
  • Cut or scrape looks infected (redness, red streak or pus)

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think you need to be seen
  • Cut or scrape and its been more than 10 years since last tetanus booster (5 years for dirty cuts and scrapes)
  • Diabetic with any toe injury

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Injury interferes with work or school
  • Injury and pain have not improved after 3 days
  • Injury is still painful and swollen after 2 weeks

Self care at home if:

  • Minor toe injury and you don't think you need to be seen
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HOME CARE ADVICE

  • Treatment of Cuts, Scratches and Scrapes (abrasions):
    • Apply direct pressure for 10 minutes to stop any bleeding.
    • Wash the wound with soap and water for 5 minutes.
    • Scrub out any dirt gently with a washcloth.
    • Cut off any pieces of dead loose skin using a fine scissors (cleaned with rubbing alcohol).
    • Apply an antibiotic ointment, covered by a Band-Aid or dressing.  Change daily.
  • Treatment of Bruised Toe: Soak the toe in cold water for 20 minutes.
  • Treatment of Jammed Toe:
    • Caution - Be certain that there is no deformity (the toe lines up normally with the other toes).
    • Soak the toe in cold water for 20 minutes.
    • If the pain is more than mild, protect it by "buddy-taping" it to the next toe.
  • Treatment of Smashed or Crushed Toe:
    • Apply an ice bag to the area for 20 minutes.
    • Wash the toe with soap and water for 5 minutes.
    • Trim any small pieces of torn dead skin with a scissors cleaned with rubbing alcohol.
    • Cover any cuts with an antibiotic ointment and Band-Aid. Change daily.
  • Treatment of Subungual Hematoma (blood present under toenail): Apply an ice bag to the area for 20 minutes.
  • Torn Nail (from catching it on something):
    • For a cracked nail without rough edges, leave it alone.
    • For a large flap of nail that is almost torn through, use a sterile scissors to cut it off along the line of the tear  (Reason: pieces of nail will catch on objects and tear further)
    • Apply an antibiotic ointment and cover with a Band-Aid. Change daily.
    • After about 7 days, the nail bed should be covered by new skin and no longer hurt. It takes about 6-12 weeks for a toenail to grow back completely.
  • Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  • Call Your Doctor If:
    • Cut or scrape looks infected (redness, red streak or pus)
    • Pain becomes severe
    • Pain does not improve after 3 days
    • Pain or swelling lasts more than 2 weeks
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American Heart Association. 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10: First Aid. Circulation. 2005;112:IV-196-IV-203.
  2. Clanton TO, Porter DA. Primary care of foot and ankle injuries in the athlete. Clin Sports Med. 1997;16(3):435-66.
  3. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93.
  4. Wedmore I, Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. 2000;18(1):85-113, vi.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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