TOE FRACTURE – BROKEN TOES

Toe Fracture Classification 

Toe fractures are categorized as follows:

• Location of fracture: Depending on the affected toe and phalanx.
• Open or closed, along with nail bed injuries
• Displacement / Rotational deformity
• Growth Plate Involvement aka Salter-Harris Classification

How Common are Toe Fractures

These are the most common foot fractures in children.

Common Injury Mechanisms include:

• Axial loading (stubbing toe)
• An abduction injury (often involves the 5th digit)
• Crush injury as a result of a heavy object falling on the foot, or maybe like a motor vehicle tire running over the foot.

Less common mechanism:

• Joint hyperextension or hyperflexion leading to spiral or avulsion fractures

How do they Clinically Look

A Toe fracture usually appears with localized swelling and bruising. Also, it is crucial to check for angulation (malalignment) and rotational deformity. The nail plate position will help with this, and compare it with the toes on the other foot. Also, it is crucial to check for significant nail bed injuries. If there is any nail avulsion or displacement out of the eponychial fold, this might be a Seymour fracture.

Signs and Symptoms

• Pain, bruising, redness, swelling
• Inability to bend or move the toe
• Inability to walk or put weight on the toe
• The toe is abnormally bent at an angle

How to Manage My Child’s Symptoms

• Rest is vital. Help your child rest so the toe heals better. Thus, he can get back to normal activities soon. Stop your child from participating in any sports or physical activity that causes pain, and encourage keeping the foot as immobile as possible. Try to limit how much weight your child puts on the injured toe.
• Applying ice on your child’s toe for 15 to 20 minutes every hour will help heal the fracture better. You can use an ice pack or put crushed ice in a plastic bag covered with a towel. Ice prevents tissue damage while decreasing swelling and pain. Never apply ice directly to the skin—always wrap it in a thin towel to avoid frostbite.
• Compression can help control swelling. Lightly wrap your child’s toe in a soft, compressive dressing or bandage, but make sure it’s not too tight.
• Keep your child’s toes elevated above the level of the heart often. It decreases swelling and pain. Therefore, set your child’s toe on pillows or blankets to keep it elevated conveniently. Resting with the foot raised slightly above the heart is especially helpful in reducing swelling.

By combining rest, ice, gentle compression, and elevation, you can help relieve your child’s pain and speed up healing while waiting to see your healthcare provider.

When to Seek Help

Parents should seek medical help for their child with a suspected broken toe if they notice any of the following signs or circumstances:

• Severe Pain or Swelling: If the child is in significant pain that doesn’t improve with rest, ice, or over-the-counter pain relief, or if the toe swells considerably and stays swollen.
• Deformity: If the toe looks crooked, bent, or out of alignment compared to the other toes, this could indicate a fracture that needs professional attention.
• Inability to Move or Bear Weight: If the child can’t move the toe, walk, or put any weight on the foot without intense pain, it’s a sign the injury might be more serious.
• Bruising or Discoloration: Extensive bruising, black-and-blue marks, or other unusual discoloration around the toe or foot could suggest a fracture or damage to blood vessels.
• Open Wound or Bleeding: If there’s a cut, puncture, or exposed bone near the injured toe, immediate medical care is necessary to prevent infection and assess the break.
• Persistent Symptoms: If pain, swelling, or stiffness lasts more than a day or two despite home care (rest, ice, compression, elevation—RICE), a doctor should evaluate it.
• Signs of Infection: Redness, warmth, pus, or a fever following the injury could indicate an infection, especially if the skin was broken.
• Young Age or Growth Concerns: For younger children, parents might seek help sooner because a broken toe could affect growth plates (the areas of developing bone), potentially leading to long-term issues if untreated.

When in Doubt

A general rule is to consult a doctor if the injury seems worse than a minor stub or if the parent is unsure about its severity. Urgent care or a pediatrician can often handle this, but an ER visit might be warranted for severe cases (e.g., obvious deformity or compound fracture). X-rays are typically used to confirm a break, though minor toe fractures might heal with just buddy-taping (taping the injured toe to a neighboring one) and rest; still, a professional should guide that call.

Key Questions for Your Healthcare Provider About a Broken Toe

When dealing with a broken toe, it’s important to have a thorough conversation with your healthcare provider. To ensure you’re well-informed, consider asking the following questions:

• Recommended Treatment Options: What treatment plan do you suggest for my broken toe? Are there any alternative treatments I should be aware of?
• At-Home Care Strategies: What steps can I take at home to relieve pain and swelling? Should I be applying ice or taking over-the-counter pain relievers?
• Recovery Timeline: How long will it typically take for my toe to heal fully? When can I safely resume my normal activities, including exercise or sports?
• Prevention Tips: What measures can I implement to avoid breaking a toe in the future? Are there specific footwear or activities I should be cautious about?
• Follow-Up and Monitoring: Will I need any follow-up appointments to monitor my healing progress? If so, how frequently should these occur?
• Signs of Complications: What symptoms should prompt me to seek immediate medical attention during my recovery process?

By asking these questions, you’ll gain a clearer understanding of how to manage and recover from a broken toe effectively, while minimizing the risk of future injuries.

What Are the Complications of Untreated Toe Fractures?

Leaving a fractured toe untreated might seem like a minor issue, but it can lead to several serious complications. Here’s what you might face if you don’t get it checked out:

• Persistent Pain: Ongoing discomfort can become a daily nuisance, impacting your quality of life.
• Bone Abnormalities: Inadequate healing could result in deformities that change the shape of your toe.
• Arthritis Risk: The chances of developing arthritis in the foot and ankle increase significantly with untreated fractures.
• Mobility Challenges: Walking might become painful or difficult, affecting your everyday activities.
• Surgical Intervention: Ignoring the fracture may necessitate surgery down the line to correct problems that could have been resolved earlier.

Early medical intervention is key to preventing these issues and ensuring your toe heals correctly.

Toe Fracture Diagnosis

When a toe becomes fractured, it usually looks swollen and bruised. If the nail is bleeding or damaged, there is likely a cut under the nail. Of course, an urgent care or emergency room can evaluate it, but our orthopedic doctors will examine your child, determine the exact problem, and provide a treatment program for your child. For proper assessment, your child may also require any of the following:

Physical Examination

When you see a doctor, they will find out how your child’s foot was injured and ask about the symptoms. Then the doctor will examine your foot while comparing it to the other foot.

For a thorough examination, the doctor will check for:

• Swelling
• Tenderness
• Bruising or discoloration (red or black-blue)
• Deformity
• Open wounds or Skin abrasions
• Loss of sensation that might indicate nerve injury

Trephination: Relieving Pressure Under the Toenail

If your child’s toe injury results in blood collecting beneath the toenail—a condition called a subungual hematoma—your healthcare provider might recommend a procedure called trephination. This involves creating a tiny hole in the nail, often with a sterile needle or a specialized device. The goal? To carefully drain the trapped blood, relieving pressure and pain while reducing the risk of further nail or tissue damage.

Trephination is a straightforward and effective approach for toe injuries where intense throbbing or discoloration appears under the nail, typically following a crush or direct trauma. Afterward, your child should feel almost immediate relief.

An X-ray

This may show a toe fracture. However, a stress fracture, which may begin as a tiny crack in the bone, may not show up in a first X-ray until it has already started to heal. It is because, during this time, a type of healing bone called a callus appears in the fracture site.

An MRI 

It may demonstrate a stress fracture or damage to the ligament. Specialists may give your child contrast liquid that will help an injury show up more clearly in pictures. Do not forget to tell the specialist if your child has ever had an allergic reaction to contrast liquid. Also, make sure you do not let your child enter the MRI room with anything metal.

Broken Toe Treatment 

Toe Fracture doctors will treat a child based on the severity of the Toe Fracture and depend on the type of fracture and the location of the injury. The proximal phalanx is the closest toe bone to the metatarsals. Since it is the longest toe bone, it is the most likely to have a fracture. A fractured toe may become tender, swollen, discolored, and sometimes deformed (if the bone is out of place). In most cases, broken toes heal without surgery. When it comes to relieving pain, taping the broken toe to an adjacent toe can sometimes help. Also, if the bone looks deformed, the doctors might have to manipulate the fracture back into place to straighten your child’s toe.

The following describes treatment from mild to severe.

• Elastic bandages, Buddy tape, or a splint – Doctors use them to keep your child’s toe in its correct position. Buddy tape means the fractured toe is taped with the toe next to it. For added comfort and to prevent moisture buildup, a small cotton wad may be placed between the toes.
• A Support Device – Specialists may recommend using devices such as a cane, crutches, walking boots, or hard-soled shoes. This helps protect the broken toe while restricting movement so it can heal faster. Rigid, stiff-bottomed shoes are often suggested to accommodate swelling and provide protection until the swelling goes down. Once it does, transition to a solid, stable shoe or a boot walker for ongoing support.
• Recommended Footwear – For optimal healing, a wide-toe shoe is advised. Additionally, a soft top is recommended to enhance comfort and avoid irritation. 
• Medicines – These help prevent or treat bacterial infection and pain.
• Closed reduction – This helps set your child’s bones back into place with no surgery. If your toe appears crooked or out of place, a healthcare provider may numb the area with a local anesthetic before gently realigning the bone by straightening the toe.
• Trephination – If blood collects under the toenail due to injury, your doctor might make a small hole in the nail using a needle or a specialized device to relieve pressure and reduce pain.
• Surgery – Experts may recommend surgery when it is a more severe break. They often require wires, pins, or other hardware to keep the bone in place while it heals. 

Each treatment approach is tailored to the type and severity of the fracture, so always consult your doctor for the best course of action.

How Can a Toe Cap Be Useful for Patients with a Toe Fracture?

A Fractured Toe Doctor will use a toe cap on children who have a toe fracture. Here’s how it can help:

• Enhanced Protection: The primary function of a toe cap is to provide a protective barrier around the injured area. This helps shield the fractured toe from accidental bumps or pressure, which can occur during daily activities.
• Prevention of Aggravation: Patients often find themselves in environments where toes are at risk, such as around playful pets or energetic children. A toe cap can help minimize the risk of further injury by absorbing impacts or stray knocks.
• Support During Physical Activities: For those involved in physically demanding tasks, whether it’s heavy lifting or constant movement, the toe cap offers an added layer of support. This is crucial in maintaining stability and promoting healing without the fear of reinjuring the toe.
• Comfort and Ease of Use: Designed to fit comfortably over the toe, these caps are typically made from soft, flexible materials. They are easy to wear with most types of footwear, making them a convenient option for everyday use.

In conclusion, a toe cap is a practical tool that not only safeguards the injured toe but also aids in the healing process by allowing individuals to continue their routines with peace of mind.

Follow-up Care

It’s essential to follow up with the healthcare provider to monitor the healing process. The duration of healing varies depending on the severity of the fracture, but can range from a few weeks to several weeks.

Parents should ensure that their child follows the prescribed treatment plan, including any activity restrictions, to promote proper healing. If parents become concerned about the progress of healing or if the pain persists, it’s crucial to seek medical advice promptly for further evaluation and adjustments to the treatment plan.

When to Contact Your Healthcare Provider

Keep an eye out for signs that may require immediate medical attention. You should reach out to your provider if you notice any of the following:

• Sudden tingling or numbness in the toes
• A sudden increase in swelling or pain
• Bleeding or the appearance of an open wound
• Fever or chills
• Red streaks running along the toe
• The toe appears crooked or bent
• Healing seems slower than expected

Additionally, it’s a good idea to schedule a follow-up visit with your healthcare provider one to two weeks after the initial injury, or sooner if your provider recommends it based on the severity of the fracture. For more significant injuries, more frequent check-ins may be necessary to ensure proper healing and to address any complications early.

Can Broken Toes Be Prevented?

While it may be challenging for a child to avoid breaking a toe in an unexpected accident, there are proactive measures you can take to minimize the risk of stress fractures:

• Listen to Your Child’s Body: At the first sign of pain during exercise or sports, pause your activities. Ignoring pain can lead to more severe injuries.
• Warm-Up and Cool Down: Ensure you warm up before and cool down after engaging in physical activities. This prepares your body for exercise and aids recovery.
• Wear Proper Footwear: Choose the right shoes for specific sports and activities. Proper footwear offers support and reduces the risk of injury.
• Around the House: Even at home, wearing shoes can protect your toes from unexpected knocks and bumps.
• Bone Health: Maintain good bone health by taking vitamin D3 supplements as necessary and paying attention to your nutritional needs.
• Maintain a Healthy Weight: Keeping a healthy weight reduces stress on your feet and legs, decreasing the likelihood of fractures.
• Consult a Professional: If you experience persistent pain in your toes, seek advice from a healthcare provider to prevent further injury.

Types of Toe Fractures: What Should You Know?

Understanding the different ways a toe can break helps you spot potential problems early:

• Traumatic Fractures: These happen after a sudden impact or direct blow—think of dropping a heavy toy chest on your foot or stubbing your toe against the coffee table. Traumatic fractures can be displaced (the bone ends move out of place) or nondisplaced (the bone cracks but stays aligned).
• Stress Fractures: These are tiny hairline breaks that result from repetitive stress, like frequent jumping, running, or even long walks in unsupportive shoes. While athletes are most at risk, anyone can develop a stress fracture if their toes are overworked or bone health is lacking.

Both types of fractures require attention. Traumatic fractures are often obvious, but stress fractures can sneak up slowly, showing up as persistent aches or swelling. If you notice any of these signs, it’s important to rest, avoid further impact, and seek medical advice.

By integrating these habits into your routine, you can better protect your toes and maintain a healthier, more active lifestyle.

By integrating these habits into your routine, you can better protect your toes and maintain a healthier, more active lifestyle.

Metatarsal Fractures

The metatarsals are the long bones between your toes and the middle part of your foot. Each metatarsal has four parts: the head, neck, shaft, and base. Even though a fracture can occur in any of these parts, they generally happen in the neck or shaft of the bone.

Treatment

Elevation and limited weight bearing will help treat these fractures. Surgery is not often necessary. However, if several metatarsals are fractured, and your foot is deformed or unstable, doctors may recommend surgery.

Fifth Metatarsal Fracture

The fifth metatarsal is a long bone on the outside of the foot. Injuries to this bone are different from fractures of the other four metatarsals. Most commonly, the fifth metatarsal fracture occurs at the base of the bone from an injury where the foot and ankle get twisted inward and downward. This injury is also known as an avulsion fracture. A Jones fracture is a transverse or horizontal fracture occurring at the base of the fifth metatarsal. This common fracture has unique characteristics, making it more likely to need surgery.

Treatment

The treatments often required are weight bearing, immobilization in a cast, walking boot, open reduction, internal fixation with plates, intramedullary screws, etc. The most suitable treatment depends on the location of the fracture, the displacements, and the activity level of the patient.

Consequences of Skipping Proper Rehabilitation for Ankle Avulsion Fractures

When an ankle avulsion fracture isn’t treated with appropriate physical therapy, it can lead to significant setbacks in mobility and overall function. Here’s what you might face:

• Long-term Functional Impairment: Your ability to walk, run, or perform daily activities could be compromised. Without proper rehab, the joint may not regain its full range of motion.
• Chronic Pain and Instability: Neglecting rehabilitation can result in persistent pain. The ankle may feel unstable, increasing the risk of future injuries.
• Development of Arthritis: Inadequate healing and weak support structures around the ankle can lead to early-onset arthritis, causing further discomfort and limitations.
• Delayed Healing process: Proper rehabilitation strategies are crucial for healing. Ignoring them may prolong recovery time, affecting your lifestyle and activities.

To ensure proper healing and avoid these consequences, it’s essential to follow a structured rehabilitation plan supervised by healthcare professionals. This helps in restoring strength, flexibility, and function effectively.

Conclusion

No matter the type of fracture – minor or serious – taking advice from our highly experienced orthopedic doctor who specializes in children will help you deal with it the right way. Following their instructions will not only help it heal faster, but also it will prevent problems like refracturing from occurring. If your child is experiencing pain or discomfort in his or her toes following a trauma or while playing, please give us a call and make an appointment with one of our pediatric orthopedic doctors.

We have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.  For a wide variety of severe injuries, Medical City Children’s Orthopedics and Spine Specialists offers thorough diagnosis, treatment, and care. Please, get in touch with us right away for treatment of a fractured toe.  Finally, our Toe Fracture Doctors will provide you with the right advice on what treatment will provide the best care for your child to quickly recover from the injury.

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Footnote:

Medical News Today:  How to Treat a Broken Toe