Synonyms and Keywords
Broken toe, compound fracture, displaced toe fracture, foot injury, foot trauma, metatarsal fracture, nail injury, open fracture, phalanx fracture, rotated toe fracture, stress fracture, subungual hematoma
What is a Toe Fracture?
A toe fracture is a break in a toe bone. Each toe is actually made up of several bones, and one or more of them may be fractured (broken) after an injury to the foot or toes. Fractures of the big toe can be much more serious than fractures of the smaller toes. Lesser-toe fractures where the bones are still aligned with each other (non-displaced fractures) usually heal successfully without many complications.
Toe fracture is a common injury that requires evaluation by a specialist. You should consult a foot-and-ankle surgeon for proper diagnosis and treatment, even if you already received initial treatment in an emergency room.
What Causes a Toe Fracture?
Because the toes are at the front of the feet, they are the most likely part of a foot to receive injuries. Almost all toe fractures happened from stubbing a toe or dropping a heavy object on a toe and crushing it. Sometimes when a toe is bent too far up or down, or the foot and toes are twisted, the trauma can cause the toe to break. Toes can also fracture after a fall or suffering a direct blow, while playing a sport, or when exercising.
Prolonged repetitive stress or movements, as in sports activities such as basketball, soccer, and running, may result in a broken toe. This is called a stress or hairline fracture.
Who Gets a Toe Fracture?
While no one is completely immune, these risk factors do increase your chance of developing a toe fracture:
- Advanced age: the older you are, the weaker your bone structures tend to be
- Decreased muscle mass: your bones become more exposed when there’s less muscle to cushion them
- Not wearing shoes: shoes provide protection against trauma that can fracture the foot or toes
- Osteoporosis: the thinning of bone tissue and loss of bone density from this disease makes the bones more brittle and breakable
- Participation in contact sports: rigorous physical competitions always increase the chance of an injury
- Poor nutrition: inadequate or unhealthy diet deprives the body of the calcium and other nutrients necessary for strong bones, thus making the bones easier to break upon impact
Are There Different Types of a Toe Fracture?
Fractures can be divided into two categories: traumatic fractures and stress fractures.
Traumatic fractures, also called acute fractures, occurred from a direct blow or impact, such as seriously stubbing your toe. Fractures of the toe bones are almost always of this variety. Traumatic fractures can be “displaced” or “non-displaced”. In a displaced fracture, the bone is broken in such a way that it has changed its position (i.e., dislocated).
Stress fractures are tiny, hairline breaks usually caused by repetitive stress. When athletes increase their running mileage too rapidly, for example, they often suffer this injury because their feet aren’t ready for the intense pounding. An abnormal foot structure, deformities, and osteoporosis can cause stress fractures, as can improper footwear. Do not ignore stress fractures, as they require proper medical attention to heal correctly.
What are the Symptoms of a Toe Fracture?
Moderate to severe pain over the fracture is the first sign. You may notice that pain lets up over a few hours and the toe starts throbbing and becomes swollen. The toe may hurt when you put weight on it or walk, especially if you’re barefoot, and you may not be able to bend or move it at all.
There may be bruises on the skin around the toe. The toe likely will not look normal — maybe even crooked, rotated in or out, or short compared to your other toes if you have a displaced fracture or a dislocation. If the big toe is fractured, the pain can make walking very difficult. You may feel numbness or loss sensation anywhere along the fractured toe, and develop a large, painful collection of purplish blood underneath the toenail. When you bend your toes or walk, you may feel crunching and grinding at the injured area, as well as tightness and increased pain, especially if the fracture is in a joint. As well, you can find the shoes painful to wear or a tight fit.
In addition, some other complications may develop, either immediately after the injury (minutes to days) or much later (weeks to years). The immediate complications include:
- Nail injury. This is in form of blood collecting underneath the toenail (called a subungual hematoma). If large enough, it will have to be drained, by a doctor making a small hole in the toenail to let the blood out. If the hematoma is very large or painful, the entire toenail may need to be removed.
- Open fracture. Rarely, the broken bone in a toe fracture may stick out through the skin. This is an open or compound fracture. Careful cleansing of the wound and possibly antibiotic medication are necessary to prevent the bone from becoming infected.
The later complications include:
- Arthritis, pain, stiffness, or even a deformity after the toe fracture heals.
- Occasionally, surgery may be called for to fix a fractures bone that would not heal completely (a nonunion), or healed improperly (a malunion).
How do You Diagnose a Toe Fracture?
It is not true that “if you can walk on it, it’s not broken,” so it’s best to seek medical evaluation of a foot specialist soon after injury to ensure proper treatment and healing. At the very least, the injured toe should be checked every day. Call a doctor immediately if any of the following occur:
- A cast or splint is damaged or broken
- Blue- or gray-colored skin
- Cold, numb, or tingling toes
- Bleeding, drainage, redness, sores, or open wounds near the injured toe
- Worsening or new pain not relieved by pain medication and conventional treatment
The doctor will ask about your symptoms, level of physical activity, how the injury occurred, and will examine the injured toe and possibly check for other injuries. X-ray is not always necessary to diagnose a broken toe, especially if the break is in one of the smaller toes.
Due to overuse or repetitive movement, stress fractures may require an MRI (magnetic resonance imaging) for diagnosis.
How do You Treat a Toe Fracture?
Treatment for a toe fracture depends on the injury’s location and severity. The doctor may need to put the fracture back into place and in a splint or cast. If there is an open wound near the injured toe, it can necessitate a tetanus shot and antibiotic medication.
Broken toes usually take about six weeks to heal. Simple fractures normally heal well without problems. A severe fracture or a fracture that goes into a joint, however, put you at risk for arthritis and perhaps even a deformity. Proper treatment can prevent these and other long-term complications with the toe joint, such as misalignment and immobility.
Self-Care at Home
You can take these measures at home to help decrease the pain and swelling, and help the fracture heal properly.
- Avoid putting weight on your injured toe by sitting until your symptoms improve or by using crutches. You can usually rent or buy crutches at a drug or medical supply store.
- Elevate your injured toe as much as you can. Lift your foot above the level of your heart. Prop your foot up on a table or chair when you sit, and on a stack of pillows when you lie down. Rest your toe and do not exercise with that foot until the toe heals. Sometimes rest is all you need to treat a traumatic toe fracture.
- Apply an ice pack or cold pack to the swollen area over your toe. You can use a bag of frozen peas or corn for this. Because the skin on your toes is very thin and the nerves are sensitive, put a thin cloth between the pack and your skin to avoid nerve damage and frostbite. Ice for 15-20 minutes at a time, at least three to four times daily or as often as hourly while letting your toe warm up to normal temperature between icing, until pain and swelling start to subside.
- “Buddy-taping” the fractured toe to another toe with cloth athletic tape or two small Velcro® straps is sometimes appropriate to stabilize the injured toe, though it does not work well if the injury is to your big toe. Put a small piece of cotton or gauze between the toes that are taped together to prevent the skin from developing sores or blisters. Use as little tape as necessary, loosely tape the broken toe to the healthy toe next to it, above and below the middle toe joint. If the toes are taped too tightly, it leads to additional swelling and can cut off circulation to the injured toe.
- Avoid walking barefoot. If you have only mild pain and swelling and are able to walk, wear a firm-soled shoe with a good amount of space for the toes to protect the injured toe and help keeps it in the proper position.
- You may consider taking a fast-acting anti-inflammatory medication such as ibuprofen (Advil or Motrin) for pain and swelling.
Professional treatment for a toe fracture depends on which toe is broken and the type of fracture. In any case, schedule an appointment with a doctor to evaluate the injured toe and make sure it is healing properly.
Options for professional treatments include:
- Ice, Elevation, and Rest. This follows the similar guidelines as for at-home care.
- Buddy Taping. The doctor may only need to tape the injured toe to the one next to it for support if the toe fracture is minor and in one of the small toes. It is usually safe to bathe and then replace the tape afterward, but check with the doctor to make sure.
- Casting. A cast is usually not required for a simple toe fracture, and a hard-soled, sturdy, supportive shoe may be used instead, or a specially customized shoe if the foot or toes are very swollen. You may need a cast if your big toe is broken, the fracture involves a joint, a lot of small fractures occur at once, or a bone in the foot or leg is also broken.
- Reduction. You may need this if your toe bone is displaced (the two ends of the broken bone are out of place) or rotated (the toe is pointing in the wrong direction). During this procedure, the doctor lines up the broken parts of bone so they can heal normally. If the toe bone is badly injured, you may need surgery.
- Medication. Antibiotics may be prescribed to help treat or prevent an infection. A tetanus shot may be given if you scratched or tore some skin to protect you against tetanus (the bacteria that causes lockjaw).
Surgery is usually necessary only when the break involves a joint, several small toe fractures, or if a bone in the foot or leg is broken too. Sometimes it is needed for a broken big toe. Surgery often involves inserting pins and screws into your bone to keep the broken parts lined up and stabilized so the toe can heal correctly.
How to Prevent a Toe Fracture?
You can take these steps to help cut down the chance of getting a toe fracture:
- Wear shoes to protect your feet, and always wear well-fitted, supportive athletic shoes when performing physical activity.
- Eat a diet rich in calcium (leafy green vegetables, almonds, shellfish, etc.) and vitamin D (egg yolks, butter, fish oil) to maintain bone density and better resist impact.
- Do weight-bearing exercises to build strong bones.
- Build strong muscles to prevent falls.