Broken Toes
Broken Toes are Common 
As a sports medicine podiatrist in San Francisco, I believe there are more broken toes then stress fractures. Broken toes are not only common but they are often mistreated. One of the reasons that broken toes are not treated properly is that many people assume that you will “just know” if the toe is broken. There is also a common misconception that “if you can walk on the foot, the toe is can’t be broken.” This is simply not true.
I see broken toes in athletes all the time. Most of the time the toe was broken by kicking a piece of furniture in the home. When this happens, there is usually immediate pain. The next day there is swelling and lots of bruising in the toe that is broken. There may also be bruising in the ball of the foot or top of the foot as well. 
 
Causes of Broken Toes
Broken toes most often happen from trauma where you accidentally kicked something that is solid and heavy like a bedpost, coffee table or doorjamb. Broken toes also happen after you drop something heavy on the toe. In either event, the toad typically swells quite a bit and becomes bruised. 
 
How Can I Tell If My Toe Is Broken? 
Bruising in the foot is one of the most suggestive signs of a fracture or broken toe. Another sign of a broken toe is a toe that is twisted, crooked, bent or tilted to the outside (away from the other toes). Another sign of a broken toe is pain. Broken toes typically hurt quite a bit when you wiggle them because you are grinding the broken pieces of bone past each other. It is not surprising that this would hurt. 

Another less common sign of a broken toe is numbness or discoloration of the toe where the toe has become white, blue or black. This can sometimes happen after a crushing type injury when a heavy object is dropped on the toe. It may be a symptom of a concerning condition called compartment syndrome. Compartment syndrome develops when a bone has broken and the bleeding from the fractured bone has cause the pressure in that toe to increase. The pressure inside the toe increases so much that it can cut off the circulation to the toe. This is a medical emergency and without immediate treatment compartment syndrome can lead to amputation of the toe.

Displaced Toe Fracture
Sometimes there is also an angular deformity in the toe that makes the toe looks like it is dislocated. In most cases the toe is not actually dislocated but instead is actually broken. The two pieces of the broken phalanx bone are separated and crooked, causing what is known as a “displaced fracture.”

The main reason it is important to treat a broken toe is that you can develop long-term problems if it is does not heal correctly. 

If the toe heals in a crooked position, it is likely going to be difficult to wear shoes. A crooked or bent toe is also more likely to catch on a coffee table or other piece of furniture in the future. This of course leads to more risk of anther broken toe later on.
 
Toe Fractures in the Joint (Intra-Articular Toe Fracture) 
Sometimes when you break a toe, the fracture line through the phalanx bone can extend into the joint and through the cartilage in the joints in your toe or in the ball of the foot. When this happens, the bone needs to be moved back into the correct position. If you let the joint line heal with the pieces of bone out of alignment you may be more likely to develop pain and premature arthritis in the toe. 
 
Ignoring a Broken Toe Can Lead to Surgery 
If the broken toe heals incorrectly because you didn’t “think it was broken” (or simply ignored it), then it is possible that you will have to have surgery later on in order to straighten the crooked toe. A crooked toe may need to be surgically re-broken and then pinned to correct the bend in the toe. 

Sometime the foot surgeon will have to remove the painful piece of bone that broke off in the joint. If you have a chunk of bone sitting in your joint it can grind away at the cartilage every time you move the toe. This of course causes joint pain in the toe. 

The worst thing is if you limp around for a month or two with a broken toe, thinking it was just bruised, but it is actually broken and heals incorrectly. You may not only need surgery, but you have essentially doubled the amount of time that it takes to heal from the injury. This is why it is so important to determine whether or not the toe is broken when it our toe is painful, swollen and bruised.  
 
Can Anything be Done for a Broken Toe?
Yes. Broken toes can be treated. And they should be treated.

If you have a broken toe that is not treated it will likely cause problems later that were entirely preventable. The first treatment of a broken toe is to realign the toe, putting the pieces of bone back together, so that it will heal correctly. If this is done by hand with a doctor manipulating the joint to realign it, is called “closed reduction.” If however the pieces of bone are too far apart or to badly damage, it might be necessary to surgically restore the alignment in the toe. Sometimes the foot surgeon will need to use small screws or surgically wire to keep the bone in position and allow the fracture to heal. This is a procedure called “open reduction and internal fixation” (ORIF) of a fracture toe.

If the toe is broken but the fracture is still in good position doctors consider this to be a “non-displaced fracture”. This is important to determine for two reasons. The first reason is that the bones will not heal correctly if they are more than a couple of millimeters apart. It is also important because if bone is close together but the pieces of bone are tilted at an angle, they can heal in the wrong position and cause problems later. 

If the fracture has happened in such a way that the two pieces of bone are still in good position then sometimes the toe can be splinted or taped in this correct position for six weeks. If held in the correct position long enough, the broken toe will heal correctly. Your podiatrist can show you how to tape the toe so that it will decrease the swelling as well as keep the toe in the correct position that helps the broken bones to heal quickly. 
 
When Is A Fracture Walking Boot Necessary to Splint a Broken Toe? 
In severe cases, it may be necessary to wear a surgical shoe or a fracture walking boot in order to fully mobilize the toe and allow it to heal. Part of the reason this is necessary is that the tendons that attach to the toe move slightly whenever you walk. If you are wearing regular shoes, you may have too much motion in the toe. Moving the broken may prevent healing of your fracture. This is particularly important if the bones are in good position but the fracture line extend into the joint and has affected the cartilage that covers the end of the bone. An intra-articular toe fracture (one that has a broken toe joint) that does not heal in good position is the most common reason that people have surgery later. In most cases, the broken toe might have healed without surgery if treated by a podiatrist immediately after the toe was broken.

The ironic part about treating broken toes is that they will generally heal in about the same amount of time whether you have surgery or not. But if you don’t treat it correctly initially and then you have to have surgery later it just takes much longer for you to actually get over the problem and get back to the activities you enjoy. 
 
Treatment for Swollen Broken Toes
Another concern about broken toes is the swelling itself that happens immediately after the toe is broken. When the toe is broken and it swells, the swelling will continue as long as the two jagged ends of the bone are moving and rubbing against each other. This causes pain and inflammation. Pain and inflammation both result in more swelling within the toe. If this continues for long enough, the swelling in the toe can actually become permanent. This is a condition that podiatrists call “sausage toe”. As you can imagine from the term, this is rather unsightly. It is very difficult (if not impossible) to fix later. 
 
When Do Broken Toes Need Surgery? 
Broken toes need to have surgery when the pieces of bone cannot be put back in position without surgery. Broken toes also need surgery when the cartilage in the broken joint has been damaged and is likely to cause premature arthritis.  Fortunately it is relatively rare that surgery becomes necessary for a broken toe.
 
How Long Does it Take for a Broken Toe to Heal?
Broken toes take about six weeks to heal if the broken bone is in good position and it is held still.  It may take longer to heal if there is excessive swelling, if the pieces of bone are moving, or if you have conditions that are known to delay bone healing. Some medical conditions that can delay bone healing are diabetes, poor blood flow in the feet and smoking. 
 
Although it may take several weeks for the broken toe to heal, the pain usually starts to go down within the first few days. If your toe still hurts occasionally when you walk or wear shoes, you should have it checked out by a podiatrist. This is particularly true if there was any bruising, or if the toe is still swollen.
 
What can I do to make a broken toe feel better? 
If you have bumped your toe or accidentally kicked a piece of furniture and the toe is painful, bruised and swollen, the first thing to do is to try to stop all of that swelling. A way to remember how to treat treat the broken toe is P. R. I. C. E. ( Protection, rest, ice, compression, elevation).
 
Protect the Broken Toe 
Protection is the first step to getting the inflammation to stop and letting the healing to begin. If the toe is broken, you have to keep it still and prevent the broken pieces of bones from grinding together. If not, you will continue to have pain, the foot will continue to swell and it will take much longer for the fracture to heal. 

Rest is important whenever you have an injury like a fracture. This is not complicated. If you get sick, you’ll get better faster if you rest. If you have a broken bone, and you rest, the broken bone will heal faster. You only have so much energy to go around and it takes a lot of energy to heal a broken bone. Rest is much as possible and decrease your activity for the  1st few weeks after the fracture.

Ice is important to stop all of the inflammation from the broken toe. The inflammation is initially present in the form of redness, swelling and heat in the broken toe. Although inflammation is part of the healing process, it can backfire. Too much inflammation causes excessive pain and prolongs the healing process. By icing the foot you will decrease the inflammation and get the healing started. Icing is also important to prevent the permanent swelling that can lead to sausage toe.

Compression also helps with the inflammation in the broken toe. If you tape the broken toe with an elastic type tape to stabilize the toe, it will also provide compression that helps push the fluid out of the toe and remove the swelling. This also will speed healing. Compression may feel uncomfortable initially. But the excess swelling is what often leads to the throbbing pain you get after a broken toe. If you remove the swelling with the compression, throbbing pain in the toe will decrease.

Elevation helps remove all of the swelling in the toe. If your foot is on the ground when you’re walking or sitting in a chair, gravity pulls the swelling down into your toe and makes it difficult to get the swelling under control. When you elevate your foot, make sure that you keep it up above your heart as this is most effective. If you sit upright on a chair at a desk and put the foot on a chair next to you, it is not on the floor but it’s not truly elevated. Elevation means up above your heart. Try to keep it elevated for the first 24 to 48 hours after you have broken the toe. Again, this will help to speed your healing and get the broken bone to heal as quickly as possible.
 
Best Shoes for Broken Toes
Many patients will want to wear soft shoes because they feel comforting but they may actually make the problem worse because they allow so much motion out at the toes. A fracture walking boot is the best protection you can have for a broken toe while you are walking. A fracture walking boot is given to you by your podiatrist when you have a severely broken toe. The toe will still heal while you’re walking on it if you’re wearing a fracture walking boot.
 
A very stiff pair of shoes is a good substitute if you do not have access to a doctor who can give your fracture walking boot. Stiff backpacking boots are typically very effective because they are super stiff and the sole of the shoe is curved. The curve in the sole of the shoe decreases the pressure at the ball of the foot and toes. In essence, the foot rolls when you are in these type of boots instead of bending at the toes. This helps it stabilize the fracture and allow it to heal. Dansko clogs can accomplish the same thing because they are also very stiff and have a curved sole.  Of course, staying off of your feet helps as well.
 
Should I See a Doctor for a Suspected Broken Toe 
If you bump your toe or accidentally kicked something and you think that it might be broken, there are a couple of reasons you should see a doctor immediately. 

When  a Broken Toe is an Emergency 
One emergency is a toe is bleeding. If the skin is actually cut or ripped open, this could be an open fracture that could become infected. Infected broken toes can develop bone infections (which doctors call osteomyelitis). Osteomyelitis is associated with a high rate of toe amputation. In most cases, the only way to cure a bone infection in the toe is to remove the infected bone by amputating the toe.

The second broken toe emergency is when the toe is pale, cold, or you cannot wiggle it. This could be compartment syndrome. Compartment syndrome is a medical emergency that must be checked out immediately. Compartment syndrome also often leads to amputation if not treated quickly. 
 
When the Toe is Probably Not Broken 
A toe that has only suffered a bruise or a contusion, will typically feel much better the next day. But the toe continues to be hurt several days after the injury, it is likely broken. 

If your toe continues to be ache for more than 24 hours after the injury it might be broken and you should have a toe x-ray. If the toe is bent or crooked you should have it checked out by a Podiatrist. If you try to wiggle the toe and you feel any grinding or clicking sensation, this is almost certainly a fracture. If you have and grinding or clicking in the toe, you must get an x-ray and see a podiatrist.
 
When Do I Need X-rays for a Broken Toe? 
Anytime a toe is broken or suspected to be broken by your podiatrist, x-rays are needed. With an x-ray, your podiatrist will be able to determine how bad the broken toe is and whether or not the fracture extends into the joint. 

X-rays of a broken toe are a simple low-cost and effective method of accurately diagnosing a broken toe and determining what the best course of treatment will be. Xrays help determine how likely it is that the toe will heal on its own. A toe X-ray helps determine how important it is to stabilize the toe, splint it or protect it with taping or a fracture walking boot.  
 
Which Doctor is Best to Fix a Broken Toe?
You have many options when choosing the best doctor to treat your broken toe. A surgical podiatrist has the most training associated with broken toes and broken toe treatment. Orthopedic surgeons are also qualified to treat fractures of the toe. 

You can always get X-rays and an evaluation at the emergency room, but this is rarely the best place to go with a broken toe. The emergency room is simply the most expensive. The doctors in the emergency room are very busy and you will likely only spend a couple of minutes with them. But you will it will probably cost over $1000 to have your broken toe evaluated in the Emergency Room. In most cases the Emergency Room physician will X-ray the toe and then simply tell you to go see a specialist like a podiatrist. If you have a good relationship with your primary care doctor, and your primary care doctor can take toe x-rays, you can simply see your primary care doctor to have your broken toe evaluated.
 
The Best Doctor for a Broken Toe 
But the very best option is probably a house call from a podiatrist. You could pre-arrange to have x-rays of the toe before the podiatrist comes to your home or office. The house call podiatrist will review the x-rays with you, evaluate your foot and determine the best treatment. All of this can happen without you even leaving your home. In most cases, this is no more expensive than going to a doctor’s office. But it certainly saves you an enormous amount of time and hassle. 

Remote Consultations for Broken Toes 
Another option is a remote consultation. This is where you get xrays, and the x-rays are sent directly to a toe fracture specialist for review.  The expert reviews the x-rays and you talk with him by telephone and/or a web conferencing program (like Skype). This allows you to get expert advice quickly and at the lowest possible cost. You and the toe expert can talk about the injury and determine whether or not it is broken without you even going to a doctor’s office. This is becoming more and more common and is a very cost-effective and time effective way for you to get the swollen, aching toe checked out. With web conferencing programs like Skype, the doctor can even show you how to tape the toe over the Internet. Obviously this is much cheaper than a house call. 
 
If the Toe Might be Broken...Get Help!
If you’re concerned that you have a broken toe, it is best to have it evaluated. Don’t fall victim to the common misconception that nothing can be done for broken toes. This simply isn’t true. If you are young and active it’s even more important to have the broken toe treated quickly...and correctly.  
  
San Francisco’s Broken Toe Expert 
Dr. Christopher Segler is a sports medicine podiatrist, internationally recognized fracture expert and foot surgeon who podiatry providing housecalls in the San Francisco, Mill Valley, Tiburon, Sausalito, Berkely, Oakland and Palo Alto. He believes that the best treatment for fractures is rapid treatment. He is an internationally recognized expert in foot fracture treatment. He has won multiple awards from the American College of Foot and Ankle Surgeons for his research on difficult to diagnose ankle fractures as well as subtle fracture diagnosis in the midfoot. He provides consultations worldwide via web conferencing. He also provides house calls in San Francisco, Marin and the East Bay. If you have a quick question about a toe you might think is broken, you can reach him directly by calling 415–308–0833. 
 

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