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Fractures of the toe bones are often under-diagnosed and under-treated. Comments like "but I could walk on it" and "it's just a toe fracture" represent the cavalier attitude we take towards toe fractures. However, sometimes toe fractures that are poorly treated can result in chronic discomfort and disability.

The Cause(s)

Toe fractures are a common problem that we see every week. We use our feet for almost every single activity, so it is not unusual for them to be injured in accidents at home, work, and/or during sporting activities.

The exact mechanism of injuries ranges in each situation, and can include:

  • falls
  • crushing injuries
  • accidentally kicking something while barefoot is common
  • jumping and landing poorly
  • stepping in a pothole
  • and more incidents that put too much pressure and weight on the toe(s)

After they occur, fractures may be:

  • open, with the bone sticking out or exposed
  • closed (with no exposure)
  • clean (i.e. broken in two) or contaminated (shattered into pieces)
  • well aligned (nondisplaced) or displaced (with rotation or angulation deformities of the toe)
  • simple two-part fractures or comminuted with multiple pieces

Toe fractures can also involve the joint (intra-articular ) or not (extra-articular). 

The Injury

Ultimately, every toe fracture is different due to its location, orientation level, and comminution. This is known as the fracture personality.

In our experience, fractures of the great toe sometimes carry greater significance, due to its importance during push-off (when running, walking, standing, etc.).

When a fracture is produced, there is also often damage to the surrounding soft tissue, such as the bone covering (periosteum), tendons, ligaments, joints, and skin. Often, it is the soft tissue damage and resultant healing with scar tissue that becomes more of a problem than the break itself. Treatment of "soft tissue disease" is therefore as important as treating the bony fracture.

The history of the patient who sustained the toe fracture is also important. Factors such as patient age, general health, nutrition, and smoking history can all affect fracture healing.

The Diagnosis

Our philosophy is to examine and x-ray all possible toe fractures in order to determine whether a fracture is present and its location and alignment (in order to properly treat the foot injury). 

The Treatment

Simple, well aligned, lesser toe fractures that do not involve the joint may be treated simply, i.e. with buddy taping of the adjacent toes to provide support and a comfortable large shoe or boot. Weight-bearing activities are usually allowed within a patient’s tolerable limits. 

Nondisplaced fractures that are intra-articular (involving the joint) may require protection with no weight bearing activity allowed for 4 to 6 weeks. This protection helps avoid displacement of the fracture with weight-bearing and possible disruption of the joint, which can result in chronic arthritis of the toe joint. 

Fractures that are displaced with significant malalignment or angulation and fractures involving the joint usually require surgical treatment. This is especially critical with fractures of the great toe. At surgery, the fracture is aligned, or reduced, and appropriate fixation applied. 

In difficult cases, an open incision may be necessary to reduce the fracture (ORIF). Fixation may involve stainless steel pins, screws or small plates. Afterwards, a protective dressing and boot are applied and weight-bearing activities are restricted for 6 weeks.

Therapy for range of motion exercises and strengthening is begun after a fracture is healed. 

Risks with these fractures and surgical treatment include anesthesia-related risks, wound healing problems or infection, and stiffness of the toe.