It's the middle of the night. You're trying
to make it to the bathroom and....crack. You hit the bed post with your
foot. After waking the rest of the family with your howls, you inspect the
toe only to find it is rapidly turning black and blue. It's a broken
toe.
The 5th or little toe is by far the most common toe that we treat
for fractures. These fractures usually occur in a spiral oblique manner
meaning that the bone breaks and spirals through the proximal phalanx (see
discussion of anatomy below). Bruising occurs due to a crack in the outer
cortex of the bone. This crack leads to bleeding in an enclosed space
(subcutaneous space) adjacent to the skin. Fractures can also be the
result of an impaction force or crushing force.
Principals of fracture care are similar regardless of the location
of the fracture. For optimal healing, apposition and alignment of the fracture
is essential.
Treatment of a broken toe
Broken toes aren't
hard to treat as long as we adhere to some of the basic principals of fracture
care.
First, it's a good idea to get an X-ray. Why? Well, the key to healing is to insure
that the fracture is aligned and shows good apposition. Without good
alignment and good apposition, the fracture will not only take longer to heal but
may heal in poor alignment and be crooked. Without an x-ray, it's
just a guess as to whether the alignment and apposition of the fracture
fragments is correct. An x-ray also confirms whether the fracture extends
into a joint. Fractures that extend into a joint will not only take longer
to heal but may have a higher incidence of arthritis in that specific joint in
years to come.
In all cases, rest, ice and elevation are important. Rest and elevation will
enable
the body to begin the natural process of healing. Ice is a simple way to mediate
the natural inflammatory response post fracture.
One recommended method of treating a broken toe is
buddy
splinting. Buddy splinting of the toes works
for some patients
but can be a challenge for others. We find a self adherent wrap such as
1 Co-Flex works well for
splinting a single toe. As an alternative to buddy splinting, we recommend that
you use Co-Flex to wrap just the injured toe. Co-Flex is used to wrap the toe in a cylindrical
manner almost like a little cast. In this way, the fracture is not only
splinted but swelling is also controlled. Co-Flex can be reused so that a
little strip can last several days. Another splinting alternative is a toe
straightened.
Single and
double toe straighteners are often used to passively re-align poorly aligned
digital fractures. And lastly, fracture shoes
are also helpful to allow for ambulation while offering enough room for the
fractured
toe.
Some digital fractures will require surgical care.
Re-alignment of the fracture can usually be accomplished through closed
reduction with or without pin fixation. Closed reduction means that the
fracture is re-aligned with the patient under anesthesia but without an open
incision. If fixation is used, pins remain in the fracture for a period of
2-6 weeks post closed reduction.
Another common problem with digital fractures is a contusion to
the nail with bruising that develops beneath the nail. This
bruising
is called subungual hematoma. Pressure that builds under the nail due to
subungual hematoma should be relieved as soon as possible. A
specialized nail drill is used to
carefully tap the bruising found beneath the nail. Under optimal
circumstances, draining the bruise should be carried out within 24-36 hours
post-injury. Patient's notice a marked reduction in pain following this
procedure. The subungual pressure caused by subungual hematoma will often
forced the nail to float away from the underlying nail bed. Over several
weeks to months, the nail will slough off and a new nail will slowly (over a
year) grow back to replace the old nail. During this time, the new nail is
very susceptible to fungal
infections and should be treated with a
topical antifungal
lotion or cream. In a limited number of cases, the new nail may grow
back to be poorly shaped and becomes ingrown. The ingrown nail can be
treated with a nail brace or by a minor
surgical procedure at your local podiatrists office.
Ice, elevation and an anti-inflammatory
medication will help to ease some of the pain. What's typically a surprise to
most folks is how long a fractured toe can take to heal. Fractured toes may take up to 10 weeks to
heal depending upon the apposition and alignment, severity of the fracture and
the patient's overall ability to heal.
