Should I go to the doctor for a Broken Toe? [Broken big toe & pinky toe]

We review broken big toe treatment & broken pinky toe treatment. What does a broken toe look like & what to do for a broken toe!

 

A broken toe is often hard to identify as the toe contains numerous small bones, joints, tendons, and ligaments. Following an injury, the toe might be just hurting or may be broken. Most people think that the toe is broken only when difficult walking, but it is not always right. Consultation with a good doctor is the only way to make sure if it is broken or not because if not treated promptly, symptoms can worsen and may lead to complications such as infection, arthritis, or long-term foot pain.

Also, consult your doctor if after injury:

  • Pain and swelling is not settling even after 2-3 days
  • Difficulty in walking or wearing shoes
  • You have diabetes or other severe illness

You should see a podiatrist as they have extensive experience and training in surgical and non-surgical foot and ankle ailments. Podiatrists are the leading experts in treating conditions involving foot and ankle. They are uniquely qualified and trained among all healthcare professionals to treat foot and ankle conditions, including surgeries.

 

What is a Broken Toe?

A broken toe also called a toe fracture, is a bone in one or more toes. Trauma or injury can often cause one or more of the toe bones to break. It can happen when your toe hits against a hard object or something drops on it.

Each toe has three bones called phalanges and two joints except the big toe, with only two bones and one joint. The smaller bones called phalanges of toes are:

  • Proximal (bone closest to the foot)
  • Middle
  • Distal (end of the toe)

The big toe contains only the proximal and distal phalanx.

It is very common among those maintaining an active lifestyle and athletes. These are often referred to as ‘Turf toe.’ Turf toe is caused by excessive explosive movements such as jumping, running, etc., and can vary from a simple sprain to a broken toe or ligament tear. The most commonly affected toe out of the five toes is the little toe, and fracture mostly occurs at the toe’s base.

A broken toe is not a medical emergency, and most of the time, it goes unnoticed. It is difficult to tell whether the toe is just hurt or broken, and treatment in both conditions is the same.

 

What are the types of toe fractures?

There are several types of toe fractures:

  • Stress fracture:

It is caused by repetitive activity, usually in athletes. It forms a very small crack in the bone.

 

  • Non-displaced fracture:

In this fracture type, bone is cracked but not broken apart, thus maintaining its position and alignment.

 

  • Displaced fracture:

Broken bones are separated completely or partially and come out of alignment.

 

  • Open fracture:

An open fracture is also called a compound fracture. In this type of fracture, an open wound or break in the skin occurs near the site of a broken toe, and it is caused by fragment of bone breaking through the skin due to injury.

 

  • Closed fracture:

In a closed fracture, skin is not broken, and bone is contained.

 

  • Avulsion fracture:

An avulsion fracture occurs when a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone. It occurs most commonly in young athletes.

 

What are the signs and symptoms of a broken toe?

It is difficult to determine whether the symptoms are broken toe or bruised skin, muscle, or bone. You may suffer from the following signs and symptoms:

  • Pain or tenderness
  • Swelling
  • Stiffness

may occur in the joint following an injury and may lead to:

  • Difficulty in walking
  • Pain while putting weight on foot, especially if the big toe is injured, bears much of the body weight. While if the little toe is injured, there’s not much difficulty in walking.

Other symptoms include:

  • Redness
  • Bruising of nearby skin
  • Numbness
  • Tingling
  • Toenail discoloration
  • Fever or chills if the wound gets infected.
  • Bony deformity
  • The crooked or misshapen appearance of the toe if the bone is displaced.
  • Bleeding under the toenail
  • Pain and difficulty in wearing shoes
  • Injury to the nail bed
  • Bleeding if there’s an open wound

 

What are the causes of the broken toe?

Toes, being the front part of the feet, make them more vulnerable to be injured. Some of the common causes of the broken toe are:

  • Trauma or injury such as stubbing the toe(jammed toes)
  • Overuse: Prolonged repetitive movements may cause stress or hairline fractures. This is common in certain sports activities.
  • Hitting against a hard object
  • Rolling the toe
  • Dropping a heavy/hard object on the toe
  • Wearing poorly fitting footwear
  • Weakened bones such as Osteoporosis or other bone disorders
  • Excessive stress on the foot

 

 

When to seek medical help?

If you drop something heavy on the toe or if the toe hits against a hard object and is hurting, it might be broken. Some people think that if you can walk with an injured toe, it is not broken. But this may not always be right, and you can have a broken toe even if you walk with it. If you put weight on your toe and you cannot bear it or are limping, it indicates that medical help is required. So consulting a doctor is the only way to determine if it is broken or not because if not treated, it may lead to infection, arthritis, or long-term foot pain.

 

Medical attention is required when you have:

  • Open wound (bone sticks out of the theskinn)
  • Bleeding
  • Toe is bent or crooked.
  • Fever or chills
  • Intense pain under the toenail
  • Numbness, tingling, or freezing sensation
  • Toe discoloration (blue or grey)
  • Swelling
  • Bruising
  • Redness
  • Difficulty in walking
  • If you have nerve damage or poor blood flow as occurs in diabetes

Also call a doctor if :

  • Pain is worsening even after taking pain-relieving medications
  • Redness
  • Sores
  • Open wound near the injured toe
  • Bruising
  • Bleeding
  • If the cast or splint is damaged.

 

 

Whom to see for Broken toe?

You can see a primary care provider initially if the toe injury is suspected. If the toe is broken, you will be referred to a podiatrist specializing in all conditions of foot and ankle or an orthopedist or orthopedic surgeon specializing in disorders of the musculoskeletal system.

As the toes contain numerous small bones, joints, ligaments, and tendons, it is often hard to determine the cause of injury, so it is important to see a foot and ankle specialist to identify the cause of injury and prevent the condition from worsening and complications.

Podiatrists are the leading experts in treating conditions involving foot and ankle. They are uniquely qualified and trained among all healthcare professionals to treat foot and ankle conditions, including surgeries.

 

How does a doctor diagnose a Broken toe?

Your doctor may take a careful history and perform a physical examination to determine the differential diagnosis.

History:

The doctor may ask the following question to determine how the toe is injured:

  • How did the injury occur?
  • Were you barefoot at the time of injury?
  • Exactly where is it hurting?
  • Is any other toe involved?
  • What associated symptoms are you having?
  • Are there any particular foot movements that exacerbate your condition?
  • Which foot movements alleviate your condition?
  • Are you taking any medications?
  • Do you have previous fractures or any bone disease?
  • Do you have any associated medical illnesses?
  • What is your occupation?
  • What is the level of physical activity you perform daily?

Examination:

The doctor will examine the injured toe and look for other injuries, too, such as a sprain.

  • Your doctor will look for tenderness (sensitivity to touch) around the affected area.
  • The doctor will also check the injuredskinn to see if the toe is receiving adequate:
    • Blood supply
    • Nerve supply

Investigations:

To reach a definitive diagnosis, the doctor may order the following tests:

  • X-ray: to evaluate if the bone is broken. X-ray is not always necessary to diagnose a broken toe, especially if the smaller toe is broken.
  • MRI: If the doctor suspects stress fracture in case of overuse or repetitive movements, MRI might be ordered.

 

What is the Treatment of Broken toe?

Treatment of broken toe depends upon the severity and location of the break. The injury is usually minor, and no treatment is required except self-care at home and pain-relieving medications. The following tips may help decrease pain and swelling from a broken toe and aid in fracture healing:

Home remedies:

If your toe is broken, these home-treatment methods can be tried in the initial few days:

 

  • Rest: Keep the foot immobile. Avoid prolonged standing, walking, or exercises. Avoid bending the toe. Crutches may be needed.

 

  • Elevation: Keep the foot elevated to avoid pain and swelling while sitting or lying, generally above the heart level or as much as possible. You can also prop the foot as much as possible by using pillows under the feet.

 

 

  • Ice: For the first 24 hours, icing the toe by wrapping ice in a towel for 20 mins every hour, and afterward, you can ice twice or thrice a day. Avoid direct application of ice. Icing reduces pain and swelling by decreasing information.

 

  • Pain-killers: Pain-relieving and anti-inflammatory medications such as ibuprofen, naproxen, acetaminophen, etc

 

 

  • Foot-wears: Keep the shoes off or, if necessary, wear wide shoes. Avoid wearing high heels or narrow shoes that crowd the toe.

 

 

Medical Treatment:

The big toe has a great role in balance, strength, and gait, so the injury is more complicated to treat. If you suspect a fracture, medical attention is required, and the treatment depends upon the severity of the break and the location of the toe break. Treatment options include:

  • Antibiotics and tetanus shot in case of open fracture.

 

  • If blood is trapped under the toenail, the doctor may drain it or remove the toenail completely.

 

 

  • Immobilization:

A simple fracture is treated by properly lining up the parts of bones and immobilization the toe so it can heal. The cast is usually not required-, and hardsoled and supportive shoes should be worn. Methods of immobilization  include:

 

  • Buddy taping:

 

In case of a small or minor fracture in a small toe bone, the injured toe is tapped to the next toe to stabilize the injured toe. Uninjured toe acts as a splint.

 

Cotton is placed between the two toes so that skin doesn’t rub, thus preventing sores or blister formation, and then the medical tape is loosely wrapped over the toes. It may alleviate pain. Tapping is needed for up to 4 weeks, and it can be removed for bathing and can be put back on afterward

 

Wrapping the toes too tight may cause swelling and poor blood supply, prolonging or delaying the healing process.

 

  • Stiff bottomed shoes: A Podiatrist might also recommend Stiff bottomed shoes with a soft/cloth top so that toes don’t bend and allow room for swelling. This also avoids weight on the toes so that they may heal properly.

 

  • Cast: If the toe is broken and bone is displaced, the Podiatrist moves the bone back together with hands under local anesthesia, and then you may get a cast. There’s no surgery involved in this procedure.

 

  • Reduction and splinting: Depending upon the severity of the fracture, such as if two bone ends of the broken toe are out of place or rotated, toe pointing in the wrong direction, or if the toe is dislocated, and they don’t fit snugly together, under local anesthesia toe may need to be reduced (maneuvered back into place) and a splint may be applied to the broken toe to hold it in place.

 

 

Surgical Treatment:

  • Surgery is needed if:
    • The big toe is broken
    • Bone is dislocated
    • Several small toe fractures
    • Foot or leg bone is broken in addition to toe.
    • Joint is disrupted or open(compound) fracture.

Serious breaks require surgery so that pins or screws are placed to hold the bone in place.

Rarely small pieces of bone can break off and prevent proper healing, so surgery is required.

 

How long does it take for a broken toe to heal?

Mostly broken toe heals in about 4-6 weeks, but it can take more time depending upon the severity of the break. Serious breaks corrected by surgery may take longer, about 6-8 weeks, and may need follow-up.

After healing, you might feel soreness or stiffness when you continue activities, but it slowly fades away as the activity increases because of stretching and strengthening of toe muscles. X-rays may also be needed to re-evaluate the bone and healing process.

During the recovery phase, the doctor advises avoiding physical activities as they may worsen the injury or delay the healing process. After healing, the doctor may advise avoiding tight shoes and high heels.

Once you can walk or wear shoes without pain, normal daily life activities can be continued. Simple toe fracture heals without any complication. At the same time, a severe fracture is at increased risk of developing pain, stiffness, arthritis, or deformity.

What are the complications of a broken toe?

Complications may occur immediately after the injury, in minutes, days, or later in weeks or years. If a broken toe is neglected or mismanaged, it could result in:

Immediate complications:

  • Toenail injury such as a collection of blood under the toenail called a subungual hematoma, which needs to be drained or if large, then nail needs to be removed.
  • Compound fracture: the broken bone may stick out through the skin, called an open or compound fracture. It is a medical emergency and requires medical (cleansing of the wound, antibiotics, and pain killers) or surgical treatment

Delayed complications:

  • Chronic pain
  • Osteoarthritis: Arthritis may occur if the fracture extends to the joints.
  • Stiffness
  • Bony deformity: The fractured bone may not heal called non-union or heal improperly called mal-union and requires surgery.

Other complications include:

  • If the skin is injured around the broken toe, there’s an increased incidence of infection.
  • Inability to walk normally
  • Motion limiting deformity
  • Non-healing and worsening of the fracture
  • Difficulty wearing shoes