Toe Fracture

CONDITION

A toe fracture happens when a bone in any of the toes is broken (Figure 1). There are two bones in the big toe, also called the first toe or great toe. There are three bones in the other (or lesser) toes. The bones in the toes are held together by ligaments, which are fibrous bands of tissue that connect bones. There is a small joint between each bone that allows the toe to bend.

• Fractures of the great toe can be much more serious than fractures of the lesser toes.
• Most fractures of the lesser toes where the bones are still aligned with each other (called non-displaced fractures) heal successfully without many complications.

Figure 1.

CAUSES

• Almost all toe fractures are caused by stubbing a toe or by dropping a heavy object on a toe and crushing it.
• Sometimes fractures happen when a toe is bent too far up or down, or the foot and toes are twisted.

SYMPTOMS AND SIGNS

• Initially, you will have moderate to severe pain over the fracture.
• You may notice that pain will let up over a few hours and that the toe will start throbbing and become swollen.
• You will have increased pain when you apply pressure to the area over the fracture.
• You may develop bruising in the fractured toe and around its base.
• You will have pain over the fracture with weight bearing and walking, especially if you are barefoot.
• You may notice crunching and grinding at the fracture site when you bend your toes or walk.
• You may have pain and tightness when you try to bend your fractured toe, especially if the fracture is in a joint.
• You may experience numbness or loss of sensation anywhere along your fractured toe.
• You can develop a large, painful collection of purplish blood underneath the toenail of your fractured toe.
• You may have a cut or a torn toenail over a toe fracture.
• If you have a displaced fracture (one in which the bones don’t line up properly) or a dislocation (which happens when the bones don’t line up properly at the joint) your toe may look crooked, rotated in or out, or short compared to your other toes.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

• You have had a stubbing or crushing injury and have moderate to severe pain and swelling over a toe that does not get better over a few hours. .
• You have moderate to severe pain, tightness or limited movement when you try to walk or bend your injured toe.
• You have injured your toe and it looks crooked, rotated in or out, or short compared to your other toes.
• You hear crunching or grinding when you bend your toe or walk.
• You have injured your toe and there is numbness or loss of sensation.
• You have a painful collection of blood underneath a toenail.
• You have a cut or torn toenail associated with pain and swelling over the tip of the toe.

Call your doctor during regular office hours if:

• You have mild pain and swelling that does not subside after two or three days following a toe injury.
• When you try to walk or bend your injured toe, you have mild pain, tightness or limited movement that does not get better in two or three days.
• Your toe still throbs two or three days after an injury.
• You notice significant bruising of any toe after an injury.
• Your toe is red and warm, especially if you have also have a fever.

SELF-CARE AT HOME

• Avoid putting weight on your injured toe by sitting until your symptoms improve or by using crutches. You can often rent or buy crutches at a drug store or a medical supply store.
• Elevate your injured toe as much as you can to decrease pain and swelling. Prop your foot up on a table or chair when you sit and on a stack of pillows when you lie down.
• You may take a fast-acting anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) for pain and swelling. (See the labels for dosing and risks.)
• You may apply an ice pack or cold pack to the swollen area over your toe.
  • Because the skin on your toes is very thin and the nerves are sensitive, place a thin cloth between the cold pack and your skin to avoid frostbite and nerve injury.
  • You may ice for 15 to 20 minutes at a time, letting your toe warm up to normal temperature between icing.
  • Ice at least three or four times daily or as frequently as hourly until pain and swelling start to resolve.
• If you have only mild pain and swelling and you are able to walk with minimal pain, protect your injured toe by buddy-taping it to the longer toe next to it using two small pieces of cloth athletic tape or two small Velcro® straps (Figure 2).
  • Tape the toes above and below the middle toe joint.
  • Buddy-taping does not work well if your big toe is injured.

Figure 2.

• Avoid walking barefoot. If you have only mild pain and swelling and you are able to walk, protect your injured toe by wearing a firm-soled shoe that has a good amount of room in the toe area.