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What is a Toe Fracture?

A fracture is defined as a break in the continuity of the bone when a force against your body is too strong for the bone to bear. A toe fracture is when one or more of the toe bones of the foot are broken after severe trauma to the toes or foot. Toe fractures are commonly divided into 2 types namely, traumatic fracture and stress fracture. Traumatic fractures occur when there is a direct impact of your toes on a hard surface. Stress fractures are tiny hairline cracks in the toes, that most commonly occurs due to repeated stress. A toe fracture is quite common in individuals with active lifestyles and athletes.

Anatomy

Anatomically, the foot is divided into the forefoot, midfoot, and hindfoot. The forefoot is the front of the foot that includes the toes. The forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Each of the phalanges has 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. Fractures occurring in the forefoot part of the foot are painful, but very often, not disabling.

Causes of Toe Fractures

A broken toe is an injury generally caused by either stubbing the toe hard or dropping a heavy object on the toe. Normally, it takes extreme force to break a bone. However, toe bones are quite susceptible to fracture as they are small bones and are located on the tip of the foot, thereby being more vulnerable to injury and fracture in the first place. Out of the 5 toes, the little toe (pinky toe) and big toes (greater toes) are the most commonly fractured toes. Sometimes, fracture of the toes may occur in connection with other complex injuries, such as a motor vehicle accident or a fall from a height onto the feet.

Signs and Symptoms of Toe Fractures

Signs and symptoms of toe fractures include:

  • Severe pain
  • Swelling
  • Bruising
  • Infection
  • Inability to walk or weight bear
  • Deformity

Diagnosis of Toe Fractures

To diagnose toe fractures, your physician will conduct a thorough physical examination to check for signs of swelling, bruising, and tender areas in your toes. Your physician will also closely inspect the skin around the injury to ascertain the toe is intact and is receiving adequate nerve signals and blood flow. If your physician suspects a fracture, he or she will order X-rays to identify the location and severity of the fracture.

Treatment for Toe Fractures

Treatment for toe fractures depends upon the severity of the fracture and may involve the following methods:

  • Rest: Adequate amount of rest by not putting excessive weight on the toe and not standing for too long can sometimes help heal a traumatic fracture.
  • Ice: Application of ice packs on the toe for 15 to 20 minutes several times a day can help reduce swelling and pain.
  • Elevation: Keeping the leg elevated above chest level especially while sleeping helps to decrease any swelling and pain.
  • Splinting: Splints may be applied to keep the toe in a fixed position.
  • Rigid shoe: A stiff-soled shoe may be recommended to protect the toe and position it correctly.
  • Casting: Casting is usually not needed for a simple toe fracture. However, if there is a fracture of the toe joint, multiple small toe fractures, or a broken big toe, then your physician may recommend a walking cast to hold the fragments of broken bones snugly together.
  • Buddy taping: The fractured toe is taped to the adjacent non-broken toe with a gauze pad between the toes. The non-broken toe acts as a splint to help keep the broken toe from moving too much.
  • Medications: This involves the use of pain-relievers and anti-inflammatory medications, such as naproxen and ibuprofen to control pain and inflammation.
  • Reduction: This method of treatment is employed for toe fractures that are displaced where the two ends of the broken bone are out of place. During reduction, the injured toe is usually numbed with anesthesia and your doctor manually manipulates and fixes the fracture fragments or dislocations into proper alignment externally without surgery. This is known as reduction. After reduction, the fractured bone will require support to hold it in place while it heals.
  • Surgery: Surgical intervention may be required in severe fractures where reduction is achieved by making an incision on the injured toe and exposing the treatment area, using fixation devices such as screws, plates, or pins internally to maintain proper alignment and position of the broken bones and to hold the bones together in place until they heal completely. These fixative devices may need to remain in the toe permanently.
  • The Arthroscopy Association of North America
  • The American Osteopathic Academy of Orthopedics (AOAO)
  • The American Academy of Orthopaedic Surgeons
  • American Orthopaedic Foot & Ankle Society┬«
    Orthopaedic Foot & Ankle Foundation
  • American Academy of Osteopathy
  • American Osteopathic Association