A broken toe is a type of bone fracture.
Toes usually break because they have been stubbed or crushed. Crushing breaks are often caused by dropping something on the toe. More rarely, over-extending a toe joint can break off a portion of the bone, and stress fractures are possible, especially just after a sudden increase in activity. Diagnosis can be based on symptoms and radiography.
Fractures of the smaller toes are usually treated with rest, buddy taping (taping the toe to the nearest toe, with some absorbent padding in-between), and wearing comfortable, wide-toed, flat, stiff-soled shoes. For pain and swelling of all toes, rest, icing, elevation and pain medication are used. Pain usually decreases significantly within a week, but the toe may take 4–6 weeks to heal fully. As activity is slowly increased to normal levels, the toe may be a bit sore and stiff. If the bone heals crooked, it may be relocated with or without surgery. Broken toes can usually be cared for at home, unless the break is in the big toe, there is an open wound, or the broken ends of the bone are displaced. In high-force crushing and shearing injuries, especially those with open wounds, blood circulation (tested by capillary refill) can be impaired, which needs urgent professional treatment. More serious broken toes may need to be re-aligned or put in a Orthopedic cast; surgery is rarely needed. These cases may take longer (six to eight weeks) to heal fully.
Broken toes are one of the most common types of fracture seen in doctor's offices, and make up just under 10% of fractures in some offices.
The AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification generates numeric codes for describing broken toes. They run 88meaning .number-code .number-code .number-code. So, for instance, 88.1.2.1 means a fracture to the big toe's innermost bone, at the proximal end. A letter can be added to describe the fracture pattern., page 99 of PDF fulltext
Injuries to the nail bed and neurovascular bundles may be present.
Malunion, healing with the bones out-of-place, can cause long-term pain and significant disability. Malunion of joint surfaces may cause degenerative joint disease. Malunions may be corrected with or without surgery.
When a toe is broken by crushing, there is often also a subungual hematoma (bleeding/bruising of the nail bed, under the toenail). If there is enough blood to cause pain, it can be drained to relieve the pain and avoid (temporarily) losing the nail. Draining is usually done if the injury is less than 24 hours old. Preserving the nail helps splint the broken toe. Contaminated wounds are more serious; the wound should be kept clean.
Broken toes with open wounds, especially if there is necrosis, can lead to osteomyelitis. Joint problems are more likely in cases of involvement/possible displacement of the joint surface and, in children, involvement of the Epiphyseal plate. Degenerative arthritis of the distal (outer) big toe joint can occur as a complication of fractures, especially fractures to the proximal (inner) end and diaphysis (midsection) of the proximal bone. If the proximal phalanx of the big toe is broken, hallux valgus (bunion) is a frequent complication.
In high-force crushing and shearing injuries, especially those with open wounds, blood circulation can be impaired.
Getting up suddenly at night, particularly when barefoot, and having a forceful impact with furniture may lead to a broken toe, also called a "bedroom fracture" "nightstand fracture" or "nightwalker fracture". Although generally associated with the fifth toe and big toe, it can occur in any toe. In such a fracture, the hard blow to the tip of the distal phalanx typically results in a transverse or oblique fracture in the proximal phalanx (base of toe), but can occur in any phalanx.
An open wound toe fracture may result from an injury from a lawn mower.
Although broken toes in horse riders are uncommon, riders are most likely to get broken toes when standing next to their horse.
If the joint was bent too far (i.e. either hyperflexion) then and avulsion fractures are common. Spiral fractures with displacement make the toe rotate and shorten. With transverse fractures (i.e. across the toe), the toe may bend abnormally.
It may be unclear whether the toe has a bone fracture or just a soft-tissue injury (such as bruising, and tendon injury). In these cases, it doesn't matter, because the treatment is usually the same for both types of injury. There is no need to figure out whether the toe is actually broken. Follow-up X-rays also generally have no effect on treatment, and are unnecessary.
X-rays are usually only taken if there are complications, or the toe is not healing as expected. If X-rays are taken, the neighbouring toes and joints are also imaged. If there is diffuse pain and tenderness across the foot, it may be necessary to X-ray the whole foot. For displaced fractures, follow-up X-rays may be taken 3-6 weeks after injury.
If a dislocated toe (a joint dislocation) is suspected, an X-ray may needed.
In people with multiple traumas, foot trauma is often neglected.
It is also helpful for shoes to be stiff-soled (to protect the toe from bending), low at the heel (even a <2cm heel can increase pressure on the forefoot by over 20%), and wide. Most shoes, especially women's shoes, have a toe box which is more than a centimeter too tight; the width of the foot should be measured standing, with weight on it. Comfortable shoes are recommended; tight, pointy shoes are undesirable. If the top of the shoe is making the broken toe more painful, it is should be changed for something that won't, like open-toe sandals or old sneakers with the toe cut away.
Somewhat more serious fractures which affect a joint, but with less than 2mm displacement and less than 25% of the area of the joint surface on the broken part, are generally also be treated with buddy taping and suitable shoes; the evidence on this treatment is not extensive.
Fractures with displacement at the break, including rotation, can often be reduced (re-aligned) by a family doctor. Some broken toes may need to be put in casts, especially if the fracture is unstable (it won't stay reduced on its own). If more than 25% of the area of the joint surface was on the broken-loose part, or the break had to be reduced, follow-up X-rays are done 7–10 days afterwards.
Fractures of the big toe are treated with a short-leg orthopedic Orthopedic boot, or a short-leg walking cast with a sole that protrudes beyond the big toe. These are worn for 2–3 weeks. Buddy taping and a rigid sole are then used for 3–4 weeks, if symptoms allow. At four weeks, range-of-motion exercises can start. If the joint was involved or the break had to be reduced, follow-up X-rays are done a week afterwards.
To reduce pain and swelling, rest, ice, elevation and over-the-counter pain medication are used. The toe is chilled with ice 20 minutes of every hour for the first waking day, and 2-3 times a day afterwards. Ice is not put directly on the skin.
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