Following in the path of last’s weeks Blog, where we discussed foreign object injuries to the foot, this week I would like to talk about broken toes! As with stepping on a foreign object, broken toes are more often than not suffered when there is a lack of shoe involvement: meaning when patients are barefoot. Of course, a broken toe injury can come at anytime, even with shoes, but that doesn’t seem to be the common occurrence.
Depending on which toe, the severity of the break, and exactly where the toe has been broken, can alter the course of treatment, so its important that we first talk about which bones are where in the anatomy of your foot.
A normal foot has 4 toes (2, 3, 4 & 5) and 1 hallux (“big toe”). Toes 2-5 have 3 small bones and one larger, longer bone. The small bones are called “phalanges,” and are named according to their location: distal (furthest from the body), middle and proximal (closest to the body). The larger bone is called a metatarsal and is named by the number toe that it corresponds to. To simplify, the third toe of the foot consists of the distal, middle and proximal phalanges and the third metatarsal bone. The hallux, or “big toe” contains only 2 small bones: the proximal and distal phalanx; and a larger 1st metatarsal bone.
Each bone communicates with the next across a joint, which is surrounded by a capsule and allows for motion to occur between those two bones: bending and extending of the toes. The joint of most importance, when dealing with toes is what’s called the “metatarsal-phalangeal joint” (MPJ). This is the joint between the larger metatarsal bone and the proximal phalanx. As we will discuss in a minute, determination of conservative and surgical treatment for a broken toe depends partly on the joint involved.
The typical “toe fracture” occurs when the toe is “stubbed” or “jammed” into the floor or into an object such as a step, or when an object is dropped onto the toe. The patient usually admits that injury has taken place while they were wearing no shoes, or slippers, neither of which provides any protection to the toes! Whether the toe was stubbed or an object was dropped on to it, pain will be immediate and swelling of the toe or toes will follow suit! You may immediately, or shortly notice bruising of the toe and/or changes in the look of the nail, if it has been injured. Rarely, the bone that has been fractured will be sticking out through the skin; an open fracture. Certainly, if bone is sticking out of the skin, a trip to the Emergency Room is a necessity.
Following injury, it is important to keep a close watch on the area involved for new pains, increased pain, or a worsening in appearance. Loss of sensation, numbness, tingling or an unusually cold toe should all throw up red flags and encourage you to seek medical attention immediately. In the mean time rest, ice, elevation and over-the-counter anti-inflammatory medications can be used to decrease swelling and pain to the injured area.
Differentiating between a fractured toe and one that is badly bruised is often difficult, unless the toe appears grossly deformed. Being that this is the case, if medical treatment is sought, an x-ray of the involved foot is likely. The x-ray will provide the Podiatrist will a lot of information to help guide your treatment: location of the fracture (if there is one), if the bones are displaced or if they are in good alignment, if a joint is involved in the fracture, how many pieces the bone is in, and whether or not conservative or surgical treatment is necessary.
If the fracture is located in one of the phalanges, is in good alignment and does not involve a joint, conservative treatment with the use of “buddy taping” and a surgical shoe to protect the toe while it heals will be initiated. If the bone appears as though it is displaced, involves the joint and is in several pieces, surgical treatment becomes a greater possibility. Surgery attempts to realign the pieces of the bone and hold them in position while they heal themselves.
As was mentioned before, involvement of the MPJ presents a bit more serious of a problem than if one of the smaller joints in the toe was disrupted. The MPJ plays a significant role in walking and provides a lot of structural support to the foot. Therefore, involvement of the MPJ will require surgery with “pin” fixation and non-weight bearing post-operatively to allow for appropriate healing to take place.
The moral of the story this week, as it was last week, is: don’t walk around without shoes on! Leaving the foot unprotected, whether it is the toes or the sole of the foot, greatly increases your risk of injury. Next time you get up off the beach blanket and head back to your summer beach house for lunch, make sure to put your shoes on and protect your feet.