Pediatric Orthopedic Surgeons treating Amniotic Band Syndrome

TOE FRACTURE

When your child has broken one of the toes in their foot, it usually occurs by stubbing the toe against something or dropping a heavy object on the foot. Depending on the complexity, injuries like these can vary from minor to major ones.  

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Toe Fracture

A toe fracture is when your child has broken one of the toes in the foot. A broken toe is a common injury that is generally caused by stubbing the toe against something or dropping a heavy object on the foot. Depending on the complexity, injuries like these can vary from minor to major ones.

If your child has a simple fracture in their toe or finger, it is supposed to heal without causing any further issues. However, in some cases, the doctor will tape the broken toe to the toe next to it in order to act as a support splint while the fracture heals. Normally, we do not cast a broken toe, but in some instances we will recommend that your child wear On the other hand, if this is a minor fracture, it will not need a plaster cast. Instead, your child may only need to wear a special boot for up to six weeks.

Depending on the severity, these fractures may take several weeks to heal. And sometimes your child may experience pain and swelling for 3-6 months.

Description of Toe Fracture

Toe and forefoot fractures are often the result of trauma or direct injury to the bone. Also, these can develop by repetitive activity (stress fracture) but not always by a single injury.

A Toe Fracture may either be:

  • Non-displaced – The bone is cracked with the ends of the bone together
  • Displaced – The end of the broken bones are completely or partially separate

A Fracture is also classified as:

  • Closed fracture – With no broken skin
  • Open fracture – The skin is broken, and the wound reaches down to the bone. Open fractures are serious because, since the skin is broken, there are high chances of bacterial infection. Opt for immediate treatment to prevent infection.

Toe Fracture Classification 

Toe fractures are categorized as the following:

  • 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 fracture 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 (mal-alignment) and rotational deformity. The nail plate position will help with this and compare with 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
  • 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.
  • 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 in a towel. Ice prevents tissue damage while decreasing swelling and pain.
  • Keep your child’s toe 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.

When to Seek Help

In the following cases, a doctor or nurse practitioner should review your child:

  • Your child has persistent or increasing pain even after taking pain relief.
  • The foot looks even more swollen
  • You have concerns in this regard.
  • The injured toe feels cold or numb
  • The toe continues to hurt even after healing.
  • You have questions regarding the condition or care of your child.

Toe Fracture Diagnosis

When a toe is fractured, it usually looks swollen and bruised. And if the nail is bleeding or damaged, it is likely that there is a cut under the nail. Urgent care or the emergency department can evaluate it. Our orthopedic doctor will examine your child and ask about the injury. 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

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 in 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 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 

Elastic bandage, 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.

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.

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.

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.

Treatments Depending on the Severity of the Toe Fracture 

Toe or forefoot treatment actually depends on:

  • The type of fracture
  • The location of the injury

Fractures of the Toes

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).

Treatment

In most cases, broken toes heal without surgery. For some days, it may be painful for your child to bear weight on the injured toe. However, as the pain reduces and you feel way more comfortable bearing weight on it, it may be helpful to wear a wider than a normal shoe. 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 in place to straighten your toe.

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, these 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 through 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 actually depends on the location of the fracture, the displacements, and the activity level of the patient.

Recovery of a Broken Toe

Healing a broken toe might take 6 to 8 weeks or sometimes longer. Our orthopedic doctors will tell you when it will be safe to start activities again or return to sports.

Conclusion

No matter the type of fracture – minor or serious – taking advice from our highly experienced orthopedic doctor 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. 

Call 214-556-0590 to make an appointment.

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