Broken Toes: Prevention and Treatment of the Most Common of Fractures

About 20 years ago, my husband took on the challenge of coaching our five-year-old daughter’s soccer team.  It should have been relatively painless, right?  They were only five.  How much trouble could he get into?

Well, this is a post on broken toes, so you know where this is going, and yes, my husband actually went there. 

While most people break a toe by dropping a heavy object on it or stubbing it against furniture, some creative individuals like to mix things up a bit.  Aaron managed to break his big toe while playing coach and kicking a soccer ball.  (And yes, he was wearing athletic shoes.)  I kid you not.  I don’t know how he does stuff like this, either. 

Prevention

Toe injuries can be prevented or lessened by wearing solid footwear.  No bare feet.  Reserve flip flops for the community showers.  If doing heavy labor, wear work boots if possible. 

Treatment

Fortunately, most suspected toe fractures do not even necessitate an x-ray.  If there is no angulation (basically the toe is straight as it should be instead of having a new twist to it) or open fracture, rest, ice, and OTC NSAIDs like aspirin or ibuprofen will be all that is necessary.  Further measures include:

• A broken toe may be “buddy-taped” or splinted to an adjacent toe using several thin straps of tape to wrap the toes together.  A thin bit of gauze may be placed between the toes as a cushion.
• Work boots or thick-soled walking shoes—anything with a semi-rigid sole to prevent flexing—will help protect the toe and reduce toe movement.

Angulated or open toe fractures should be evaluated by a medical doctor. 

Angulated fractures should not be buddy-taped.  They must first be reduced and a digital nerve block will be highly desirable for the procedure. 

An open fracture of the toe, where the bone protrudes or has penetrated the skin, must not be buddy-taped, either.  It will also need to be thoroughly irrigated, cleaned, and closely monitored.  A laceration overlying a broken toe may be sutured within the first 24 hours. If any signs of infection (additional redness and/or swelling, beyond what occurred initially as the result of the injury), heat, or pus develop,  the patient should begin taking an antibiotic immediately.  Keflex, Augmentin (or erythromycin in the penicillin-allergic), and levofloxacin are commonly used in this situation. 

While fractures of the big toe are more serious due to the big toe’s involvement in maintaining a normal gait and balance, in general, fractures of the smallest toe are more common and usually only require rest, ice, and OTC pain relief.  And while rest is nice, in most cases it isn’t even entirely essential.  Most patients resume normal daily activities fairly quickly. But if it is the big toe involved, special measures need to be taken.

Like with the other toes and other fractures, if the big toe appears crooked, it needs to be straightened.  As traction will need to be applied, basically pulling the end of the toe away and then gently lining it up and slipping it back into place, it is going to hurt.  After the toe is as straight as possible, buddy tape it to the adjacent toe.  Because the injured toe may continue to swell, use Coban or Vet-Wrap so that it can be loosened and re-wrapped as necessary.  

Fractures of the big toe often involve the growth plate or joint surface.  As a result, they may result in arthritis or deformity regardless of the age of the patient at the time of injury.  In contrast to the smaller toes, when the big toe is involved, it is essential to avoid walking on it for at least a few weeks to allow it to heal properly and preclude further damage.

Links to related posts:

Is It Broken?  Differentiating Between Sprains and Fractures

References:

Cynthia Koelker, Armageddon Medicine, 2012, 310-311.

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