TOE FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in one or more bones of the toes.
BODY PARTS INVOLVED
Any of the bones of the toes.
Joints between the toes, and joints between the foot and toe bones.
Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal toe and foot contours.
Tenderness to the touch.
Numbness or coldness in the toe if the blood supply is impaired.
CAUSES
Direct blow to the toe, as when kicking or being stepped on.
Indirect stress to the toe. Indirect stress may be caused by twisting.
RISK INCREASES WITH
Sports that require shoes with cleats.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
HOW TO PREVENTWear appropriate footgear for running and participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate and set the broken bones.
Self-care during rehabilitation.
Whirlpool, ultrasound or massage (to displace excess fluid from the injured joint spaces).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the toe and foot.
POSSIBLE COMPLICATIONS
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues.
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Unstable or arthritic toe joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated toe injury.
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex, and previous state of health and conditioning. The average healing time for this fracture is 6 to 8 weeks, but you may begin weight-bearing right away. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Cut away the shoe and sock, if possible, but don't move the injured toe to do so.
Follow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION AND ELEVATION. See Appendix 1 for details.
The doctor will realign the broken bones with surgery or, if possible, without. This manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. Place felt between the fractured toe and a good toe, then fix the two toes together with adhesive strips. Cut the top of the shoe out and have a shoe repairman apply a bar on the sole of the shoe (metatarsal bar). Then bear weight on the foot as pain allows.
Use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, heat ointments and liniments, or whirlpools.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Elevate the foot whenever possible.
Actively exercise all muscle groups in the foot that are not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Begin reconditioning the injured foot after clearance from your doctor.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a toe fracture.
Any of the following occurs after treatment or surgery:
Blue or gray skin color, especially under the toenail.
Numbness or complete loss of feeling in the toe.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above the taped area.
Nausea or vomiting.
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