The Low down on Broken Toes
I often hear: “it’s broken toe, there’s nothing you can do about it” …and it always make me cringe; of course there is!
Treatments don’t always mean an instant fix, but properly treating a broken toe will reduce healing time, decrease risk of non-healing, improve function and manage pain; now that sounds like something does’t it?
There’s lots to do, so let’s get started.
Get an X-ray
If you injured your foot and suspect a broken toe, I really do recommend seeing a doctor and getting an X-ray as soon as possible. This can be done at an Urgent care, or most podiatry and orthopedic offices. The nature of the fracture seen on X-ray will tell you a lot about your injury. Fractures are not all the same and they can not be properly diagnosed just by exam. The direction of the crack, the position of the two pieces, if there is any gapping between the fracture fragments all contribute to assessing the severity of the fracture. These characteristics help determine what level of treatment is needed and expectations for healing. You also want to make sure that the Metatarsal bone (the long bone of the foot that meets the toe) is not injured. You also want to make sure that the joint is not damaged.
If there is an injury to the Metatarsal or Metatarsal Phalangeal Joint - You will need more aggressive treatment than if it was just the toe. These treatments can include crutches, cast, walking cast boot, sometimes surgery.
Respect the Big Toe
That big toe has a big job, it bears all of your weight when walking for a brief second. It warrants more protection to allow healing than the other “little” toes.
IMMOBILIZE, Protect & Keep Weight off
Buddy Splint
The most important components to treating a broken toe are immobilization and protection. Immobilization will keep those two broken pieces from separating when you are walking. Those pieces need to be in direct contact or as close as possible for optimal healing. Immobilization for a broken toe usually comes in the form of a buddy splint. I have seen many iterations of these buddy splints - if not done properly it can hurt more than it helps. The crisscross method shown in the image here is my preferred technique. You can use skin safe paper tape for this method. Another option is using a pre-made velcro toe splint.
Protection is needed so that the stress of walking doesn’t worsen this fracture or prevent its healing. This can come in several forms and will evolve with your healing. Initially keeping weight off the injury completely may be needed. If you haven’t seen a doctor yet but it is painful to walk, staying off it is best until you are assessed by a doc. This may even be part of the doctors plan once your X-ray is evaluated. A cast may be needed depending on the severity and location of fractured bone.
A CAM boot or walking cast boot is a common mode of protection for fracture. Bone healing in the foot can take 6-8 weeks. A CAM boot is used to allow you to walk without crutches when indicated. The boot will decrease the amount of force on the fracture while walking.
Surgical / Post op / Cast shoe- This is a low top, velcro, hard soled shoes often dispensed by a doctor. This will also provide protection to the area of injury. I reserve this for the most mild of injuries and for those patients that will not be doing a lot of walking. The shoe itself is not made for walking distance. If you are still commuting to work or active and walking I would opt for the CAM boot even if the injury is mild.
If you have been diagnosed with a broken toe remember healing takes time. Every week or so your injury is healing and evolving needing different things. Initially rest, protection, immobilization, possible icing, pain management. The next weeks the pain may have subsided a bit, you may need more protection and immobilization now that you are walking. Maybe the area is still after 4 weeks and you need gentle movement.
Later, what you will need most is patience for this injury. You will be impatient with the time it takes to heal but remember you can’t rush the process. But pushing an injury that is not ready, you will only restart or add time to the clock.
-Be well, Dr. D
Here are some supplies to help you get back on your feet safely:
Adjustable Crutches Cast Shoe CAM boot Ice pack Buddy Splint Tape
Medical Emergencies:
If you have a medical emergency, whether it is related or unrelated to COVID-19, you should call 911 and go to the emergency room. This includes any injury or illness for which a lack of immediate treatment may cause harm. This can include, among other things:
Trouble breathing
Passing out, fainting
Pain in the arm or jaw
Unusual or bad headache, particularly if it started suddenly
Suddenly not able to speak, see, walk, or move
Suddenly weak or drooping on one side of the body
Dizziness or weakness that does not go away
Inhaled smoke or poisonous fumes
Sudden confusion
Heavy bleeding
Possible broken bone, loss of movement, particularly if the bone is pushing through the skin
Deep wound
Serious burn
Coughing or throwing up blood
Severe pain anywhere on the body
Severe allergic reaction with trouble breathing, swelling, hives
High fever with headache and stiff neck
High fever that does not get better with medicine
Throwing up or loose stools that does not stop
Poisoning or overdose of drug or alcohol
Suicidal thoughts
Seizures