Toe Fractures: Options To Treat and Heal Them (Yes, Toe Fractures Do Need To Be Treated)

Published: 16th July 2009
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Toe fractures are very common, and often are an under treated medical condition. Conventional wisdom states that they cannot be treated, and fractured toes are often left alone. Unfortunately, this can sometimes lead to significant problems down the road, especially if the bone fragment had shifted during the original injury or during recovery. What follows is a discussion on how toe fractures occur and the anatomy of the toe bones, as well as a discussion of how they can be treated to maximize recovery.



The toes are obviously short appendages at the end of the feet, with little active function at this point in our evolution. Primarily a flexible stabilizer during the end of the body's walking cycle, each toe is a somewhat complicated mix of bones, tendons, and blood vessels. The four smaller toes have three bones each, called phalanges (each called a phalanx). The big toe contains only two of these bones. Toe fractures are not too hard to create. Simply stubbing one's toe against a hard object is sufficient to break one of the small bones. Dropping heavy objects on the toes also can form cracks in the bone, and even injuries that flex the toe up, down, and to the side will force the bone to break. These breaks in the bone structure can run from simple hairline cracks to chips along the side of the bone to outright breaks across the entire bone with crushing of the bone substance possible. Often the bone fragments will stay in place, however, displacement can occur with the bone piece moving to one side or up/down from its original position. If this displacement has occurred, the bone pieces may not mend properly as bone needs to be relatively close to itself in order to heal. If they do mend, it may create a new prominence under the toe skin which can eventually irritate the skin when the toe next to it or a shoe rubs on that part of the toe, creating a corn or even a wound in the process. If the fracture line went through a joint and the bone shifted, the abnormal position of the joint can eventually cause pain and arthritis.



Treatment for toe fractures is usually fairly simple, but can become more involved depending on the severity. If a simple fracture has occurred where no fragment was displaced, then simply taping it to an adjacent uninjured toe (like a splint) while the bone heals (5-6 weeks) should be enough to keep the bone from moving during recovery. The use of a hard-soled boot/shoe or even a surgical recovery shoe will keep the toes from flexing up and down, which will further help the pieces stay in place. If the fracture fragments have moved, then several options are available to ensure proper healing. If the fracture is treated early enough, sometimes the toe can be numbed with a simple local anesthetic and the bones can be manipulated back into position by a physician. The toe is then treated as if the fracture had not moved, although the taping may need to be more secure. If this does not work, surgery may be necessary to place the bone back into position, with a metal pin holding it in place (or screw if in the big toe) until healing has occurred. All of this is done to ensure proper anatomic healing of the toe bone with little to no disruption to the surrounding tissue. Without proper healing, long term problems can potentially occur. In the case of more severe fractures when bone crush has occurred, the pieces may be too small to put back together. Unfortunately, salvage is often the only option and loose fragments may have to be removed surgically to prevent future pain. The bone and joint may have to be remodeled to provide the most comfortable result, at a loss of normal anatomy and position.



As one can see, toe fractures can become much more involved than one might assume. After injuring a toe, it is always a good idea to have a quick evaluation by a physician with x-rays to ensure that a more significant injury has not occurred. The conventional wisdom that no treatment can be provided to a toe fracture is wrong, and following that line of thought could lead to future toe problems.





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Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at www.inpodiatrygroup.com

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