What is a toe fracture?
The toe extends from the ball of the foot to the tip of the toe. The big toe is made of two bones called phalanges and the rest of the toes are made of three phalanges. A joint is between each of these bones. The one just behind the toenail is called the distal interphalangeal joint (DIP) in the little toes and the interphalangeal joint (IP) in the big toe. In the little toes, the most flexible joint, about halfway between the toenail and the ball of the foot, is called the proximal interphalangeal (PIP) joint.
A fracture is a bone that has been broken into more than one piece. To a doctor, there is no difference between a fracture and a broken bone. Toe fractures are very common. They commonly occur either through a jamming mechanism, such as kicking the leg of a table, or crushing mechanism, such as dropping a weight on it. They are usually very painful. Throbbing is common and last from several days to a week. The throbbing begins when the toe is allowed to become dependent, meaning significantly below the level of the heart for a period of time.Pain medication will due little to dampen the throbbing pain. Usually the only way to quiet it is to elevate the foot. Because the fractures bleed under the skin, there is usually a great deal of bruising and swelling.
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What do I do about toe fractures?
As long as the fracture is in good alignment, which is 95% of them, they are allowed to heal in place. Healing typically occurs within 4-6 weeks although swelling and some degree of pain especially with activity is common for several months. During recuperation, a special shoe is generally unnecessary as long as you can find a slipper or sandal which is comfortable and roomy enough to accommodate the swelling and tenderness. A loose fitting sock can be usually worn and casting, splinting, or taping the toes together is generally not necessary, although it can be done to help with the pain.
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What treatment should I expect?
While nearly all suspected toe fractures should be evaluated radiographically and clinically by a doctor, usually it is not necessary to rush into an emergency room for a toe fracture. Most toe fractures can be treated quicker and more economically in the office of a family practice doctor, internist, or other general practitioner. Occasionally, a specialist such as a podiatrist or orthopedist may be necessary, depending on the experience of your primary care physician with these injuries and the complexity of the fracture.
Immediate attention is necessary if the toe appears dusky, drastically out of position or if there are any associated cuts or bleeding. You will also need to go to the emergency room if you cannot see your primary care doctor immediately and the pain is more than acetaminophen (Tylenol) is able to control.
It is probably best to avoid anti-inflammatory medications such as ibuprofen (Motrin), naproxen sodium (Naprosyn), and aspirin because the “blood thinning” effect of these medications may increase the bruising and swelling. In addition, some doctors may have hesitation in performing surgery or may delay surgery on patients that have recently taken then these medications in the rare situation that surgery is necessary.
Toe fractures follow the same time course of treatment that other fractures do. Typically, after 4 weeks, 50-70% of the pain has resolved. After 2 months, 90% of the pain should be gone. By 4-6 months, the pain and discomfort should be nearly gone. If the pain continues at a level that is greater than this, further evaluation possibly a repeat radiograph should be done. Complications or late surgical reconstruction are rare.
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