The toes consist of multiple osseous (bones) and soft tissues including tendons, nerves, and ligaments, that support our body weight. Each toe has several small bones called phalanges that connect to metatarsals, the longest bones in our midfoot. Each toe is made up of three phalanx bones, which are the proximal, middle, and distal, except for the big toe which only has two phalanges, the proximal and distal. The primary function of your toes is to provide posture and balance, support the body weight, and propulsion during the gait cycle. Not only do your toes help thrust your body forwards when you walk, they actually help increase the length of your stride, allowing you to run faster.
A broken toe is a very common injury, especially in athletes and those with active lifestyles. Out of the five toes (also known as digits of the feet), the pinky toe is the most commonly broken toe, with the fracture often occurring at the base of the toe. Your toes make up a portion of your foot referred to as the forefoot. Four of your toes are comprised of 3 bones called phalanges, and two joints. The big toe, however, is made up of only two bones and one joint.
As mentioned earlier, the three smaller bones, or phalanges, of the toes are the:
- Proximal (the bone closest to the foot)
- Distal (the end of the toe)
The big toe only has the proximal and distal phalanx bones.
Causes & Symptoms
Generally, there are several ways to categorize your toe fractures, as follows:
- Stress fracture – A stress fracture is a small crack in the bone. This can occur from repetitive trauma and is commonly seen in athletes. Stress injuries are normally found in the heel, shin bone, lower back, and foot (where the toes are located).
- Open fracture – An open fracture is a fracture in which there is an open wound or break in the skin near the site of the broken bone. Most often, this type of wound is usually caused by a fragment of bone breaking through the skin at the moment of the injury.
- Closed fracture – A closed fracture is a break or crack in the bone that does not come through the skin but sometimes causes injury to tissues in the area. A closed fracture can vary in severity, depending on what bone is affected and how large the crack or break is. Because the skin is not opened in a closed fracture, the risk of infection or complications from exposure to the air is lower.
- Avulsion fracture – An avulsion is where a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Ligaments hold your bones, joints, and organs in place while tendons connect muscles and bones. In an avulsion fracture, your bone moves one way, and your tendon or ligament moves in the opposite direction with a broken chunk of bone in tow.
In addition to the different types of toe fractures that are associated with this condition, displaced and non-displaced fractures differ in the breakage of the bone. Whereas in non-displaced fractures the bone does not always crack all the way through, displaced fractures are out of alignment. When the bones are out of alignment, surgery is often required to repair the broken toe.
With the numerous small bones, joints, muscles, tendons, and ligaments in your toes it can be very difficult to identify what type of injury you are suffering from. Broken toes typically result from trauma or injury to the foot or toe. Injuries such as stubbing a toe or dropping a heavy object on a toe may cause a fracture. Oftentimes, a broken toe may result from prolonged repetitive movements, as in certain sports activities, such as basketball, football, soccer, or lacrosse.
During symptoms linked to broken toes, throbbing pain in the toe is the first sign that it may be broken. You may also hear the bone break at the moment of injury. Additionally, a broken toe may also cause rapid swelling at the break. If you have broken your toe, the skin near the injury may look bruised or temporarily change in color. You’ll also have trouble adding weight on your toe, therefore, symptoms may worsen. Certain motions such as walking, standing, running, or crouching can increase pain in your affected toe. A bad break can also dislocate the toe, which can cause it to rest at an unnatural angle.
Unlike a sprained toe, it shouldn’t look dislocated. It will likely still swell; however, it will probably have much less bruising. A sprained toe can be painful for many days but should normally begin to improve quite quickly. One main difference between a break and a sprain is the location of the pain – typically, a broken toe will hurt right where the bone has fractured. The only way to determine if the injury is a break or a sprain is to seek a diagnosis regarding your broken / fractured toe.
Who gets a Broken Toe?
Certain risk factors associated with broken toes include the following below:
- Participation in certain sports – Participation in high-impact sports, such as running, soccer, basketball, and lacrosse can increase the likelihood of sustaining a broken toe in either foot.
- Bone insufficiency – Osteoporosis and low levels of vitamin D can decrease bone density and strength, which may result in an increased chance of experiencing a toe fracture.
- Previous toe fractures – Having a previous toe fracture increases the chance of developing another in the same toe, or in severe cases, a broken toe.
- Age – Newborns are more likely to experience a broken toe due to weakened bones after birth.
How Does it Affect You? How Serious is it?
The most common complication of a broken toe is trauma to the toenail of the damaged toe. Toenails may become discolored, turn blue and black, and even fall off. The toenail will normally re-grow, however, it is often recommended to seek immediate treatment to avoid infections. Also, if a broken toe isn’t treated properly, failure to heal or heal in an incorrect position can occur. This can cause deformity and chronic pain down the line and may cause the surgery to be done.
Other possible complications of a broken toe include:
- Decreased athletic performance
- Severe discomfort
- Amputation (in the most extreme cases)
Recommended Treatment & Rehabilitation
During a diagnosis of a broken toe, your doctor will begin by checking for any tender areas in all your toes. Your doctor will also check the skin around your injury to ensure it is intact and that the toe is still receiving a regular amount of blood flow and nerve signals. If a broken toe is suspected, he or she will most likely order X-rays to get a clearer view of your foot taken from various angles.
If your toe has truly been broken, then surgery may be required. The most common type of surgery for broken toes is open reduction and internal fixation. To begin with the procedure, your surgeon will administer regional anesthesia. In some cases, sedation may also be provided. Afterward, a small incision is created down the length of your toe to access the fractured areas. Your surgeon will then place the bone fragments in their correct positions, then secures them into place using surgical screws, plates, or rods. Lastly, the incisions are closed with surgical staples or sutures. The area is then covered with a surgical dressing and protected with a cast or a splint. Normally, the length of surgery depends on the extent of the damage. But in most cases, toe surgery can be completed in approximately two hours.
Immediately after a broken or fractured toe injury, the following treatment plans can help heal pain and prevent further injury. A physiotherapist will most likely perform this treatment method known as the PEACE method, as described below:
- Protect – Your physiotherapist will limit movement and use pain as a guide to avoid causing discomfort.
- Elevate – He or she will put your feet up at about heart level to increase blood circulation.
- Avoid anti-inflammatory medications – Inflammation is the first stage of the body’s natural recovery process. You do not want to disrupt your recovery if you take anti-inflammatory drugs (NSAIDs).
- Compress – Putting pressure on the toe / foot (such as when using a compression sock) may help limit swelling. Too much compression can restrict needed blood flow. Your physiotherapist will choose the perfect amount of compression to help treat your toe injury.
- Education – Your physiotherapist will educate you about the injury and instruct you on an active approach to recovery and your options for treatment. He or she will also determine when it is safe for you to return to your regular activities.
After the treatments above have been done, your physiotherapist will work with you to design a proper treatment program specific to your goals to finish recovering from your broken toe. Some of these treatment plans may include:
- Range-of-motion exercises – It is important to regain the full range of motion of your big toe and foot. If your injury required the use of a brace or boot to restrict movement during healing, your toe and foot joints may be stiff. Your physiotherapist will then teach you gentle stretching and movement exercises to help restore normal movement.
- Muscle-strengthening – It is common to lose strength in the muscles of your foot, ankle, and leg after a broken toe injury. This is due to the change in activity and any bracing or boot used to restrict movement during healing. Your physiotherapist will determine which muscles are weak and teach you specific exercises to strengthen them.
- Manual therapy – Manual therapy can be especially effective to restore movement in joints that become stiff after being immobilized. Your physiotherapist may gently move the joints involving your injury for you. This might feel like your foot is being gently wiggled.
Below are a few exercise examples for you to try at home:
- Toe curl – Sit on the floor, with the heel of your affected foot on the floor. Next, gently curl your toes forward and then backward. Hold each position for about 6 seconds. Repeat 8-12 times a day.
- Towel scrunches – Sit in a chair and place your affected foot on a towel on the floor. Then, scrunch the towel toward you with your toes then use your toes to push the towel back into place. Repeat 8-12 times a day.
- Marble pick-ups – Put some marbles on the floor to lift up, one marble from the floor at a time. Then try to put the marble in the cup. Repeat this method 8-12 times a day.
- Towel stretch – Sit with your legs extended and knees straight. Next, place a towel or belt around your foot just under your toes. Hold both ends of the towel or belt, with your hands above your knees. Pull back with the towel or belt so that your foot stretches toward you. Hold the position for at least 15-30 seconds, then repeat 2-4 times a day.
Alternative & Homeopathic Treatment
There are many different ways to ease your broken toe homeopathically – some of these alternative treatments include:
- Ice application – An ice pack can help relieve toe pain. This option could be particularly useful for patients with foot pain in the joints of their feet due to trauma, infection, inflammation, or arthritis.
- RICE method – RICE stands for rest, ice, compression, and elevation. Many athletes tend to follow this method in order to rule out further symptoms linked to a broken toe.
- Foot shower – Patients can bathe sore, painful, or tired feet in a bowl of warm water. Some individuals find that adding Epsom salts to the water can help ease the soreness much further.
- Fish oil – Omega-3 oils are perfect for supporting nerve health and preventing foot pain.
- Massages – Having a foot massage by a massage therapist can help seek out tender spots in your affected toe and other areas in your feet and press on them, while gently stretching.