Foot & Toe Fractures

Frac­tures of the toe and metatarsal bones are com­mon and require eval­u­a­tion by a spe­cial­ist. A podi­atric foot and ankle sur­geon should be seen for prop­er diag­no­sis and treat­ment, even if ini­tial treat­ment has been received in an emer­gency room.

What is a Fracture?

A frac­ture is a break in the bone. Frac­tures can be divid­ed into two cat­e­gories: trau­mat­ic frac­tures and stress fractures.

Trau­mat­ic Fractures

Trau­mat­ic frac­tures (also called acute frac­tures) are caused by a direct blow or impact-like seri­ous­ly stub­bing your toe. Trau­mat­ic frac­tures can be dis­placed or nondis­placed. If the frac­ture is dis­placed, the bone is bro­ken in such a way that it has changed in posi­tion (dis­lo­cat­ed). Treat­ment of a trau­mat­ic frac­ture depends on the loca­tion and extent of the break and whether it is dis­placed. Surgery is some­times required. Signs and symp­toms of a trau­mat­ic frac­ture include:

• You may hear a sound at the time of the break
• “Pin­point pain” (pain at the place of impact) at the time the frac­ture occurs and per­haps for a few hours lat­er, but often the pain goes away after sev­er­al hours
• Devi­a­tion (mis­shapen or abnor­mal appear­ance) of the toe
• Bruis­ing and swelling the next day
• It is not true that ​“if you can walk on it, it’s not bro­ken.” Eval­u­a­tion by the podi­atric sur­geon is always recommended

Stress Frac­tures

Stress frac­tures are tiny, hair­line breaks that are usu­al­ly caused by repet­i­tive stress. Stress frac­tures often afflict ath­letes who, for exam­ple, too rapid­ly increase their run­ning mileage. Or they may be caused by an abnor­mal foot struc­ture, defor­mi­ties, or osteo­poro­sis. Improp­er footwear may also lead to stress frac­tures. Stress frac­tures should not be ignored, because they will come back unless prop­er­ly treat­ed. Symp­toms of stress frac­tures include:

• Pain with or after nor­mal activity
• Pain that goes away when rest­ing and then returns when stand­ing or dur­ing activity
• “Pin­point pain” (pain at the site of the frac­ture) when touched
• Swelling, but no bruising

Sprains

Sprains and frac­tures have sim­i­lar symp­toms, although some­times with a sprain, the whole area hurts rather than just one point. Your podi­atric sur­geon will be able to diag­nose which you have and pro­vide appro­pri­ate treat­ment. Cer­tain sprains or dis­lo­ca­tions can be severe­ly dis­abling. With­out prop­er treat­ment they can lead to crip­pling arthritis.

Con­se­quences of Improp­er Treatment

Some peo­ple say that ​“the doc­tor can’t do any­thing for a bro­ken bone in the foot.” This is usu­al­ly not true. In fact, if a frac­tured toe or metatarsal bone is not treat­ed cor­rect­ly, seri­ous com­pli­ca­tions may devel­op. For example:

• A defor­mi­ty in the bony archi­tec­ture which may lim­it the abil­i­ty to move the foot or cause dif­fi­cul­ty in fit­ting shoes
• Arthri­tis, which may be caused by a frac­ture in a joint (the junc­ture where two bones meet), or may be a result of angu­lar defor­mi­ties that devel­op when a dis­placed frac­ture is severe or hasn’t been prop­er­ly corrected
• Chron­ic pain and long-term dysfunction
• Non-union, or fail­ure to heal, can lead to sub­se­quent surgery or chron­ic pain 

Treat­ment of Toe Fractures

Frac­tures of the toe bones are almost always trau­mat­ic frac­tures. Treat­ment for trau­mat­ic frac­tures depends on the break itself and may include these options:

Rest Some­times rest is all that is need­ed to treat a trau­mat­ic frac­ture of the toe.

Splint­ing The toe may be fit­ted with a splint to keep it in a fixed position.

Rigid or Stiff-Soled Shoe Wear­ing a stiff-soled shoe pro­tects the toe and helps keep it prop­er­ly positioned.

“Bud­dy Tap­ing” Bud­dy tap­ing the frac­tured toe to anoth­er toe is some­times appro­pri­ate, but in oth­er cas­es it may be harmful.

Surgery If the break is bad­ly dis­placed or if the joint is affect­ed, surgery may be nec­es­sary. Surgery often involves the use of fix­a­tion devices, such as pins.

Treat­ment of Metatarsal Fractures

Breaks in the metatarsal bones may be either stress or trau­mat­ic frac­tures. Cer­tain kinds of frac­tures of the metatarsal bones present unique challenges.

For exam­ple, some­times a frac­ture of the first metatarsal bone (behind the big toe) can lead to arthri­tis. Since the big toe is used so fre­quent­ly and bears more weight than oth­er toes, arthri­tis in that area can make it painful to walk, bend, or even stand.

Anoth­er type of break, called a Jones frac­ture, occurs at the base of the fifth metatarsal bone (behind the lit­tle toe). It is often mis­di­ag­nosed as an ankle sprain and mis­di­ag­no­sis can have seri­ous con­se­quences since sprains and frac­tures require dif­fer­ent treat­ments. Your podi­atric sur­geon is an expert in cor­rect­ly iden­ti­fy­ing these con­di­tions as well as oth­er prob­lems of the foot.

Treat­ment of metatarsal frac­tures depends on the type and extent of the frac­ture and may include:

Rest Some­times rest is the only treat­ment need­ed to pro­mote heal­ing of a stress or trau­mat­ic frac­ture of a metatarsal bone.

Avoid the Offend­ing Activ­i­ty Because stress frac­tures result from repet­i­tive stress, it is impor­tant to avoid the activ­i­ty that led to the frac­ture. Crutch­es or a wheel­chair are some­times required to offload weight from the foot to give it time to heal.

Immo­bi­liza­tion, Cast­ing, or Rigid Shoe A stiff-soled shoe or oth­er form of immo­bi­liza­tion may be used to pro­tect the frac­tured bone while it is healing.

Surgery Some trau­mat­ic frac­tures of the metatarsal bones require surgery, espe­cial­ly if the break is bad­ly displaced.

Fol­low-Up Care Your podi­atric foot and ankle sur­geon will pro­vide instruc­tions for care fol­low­ing sur­gi­cal or non-sur­gi­cal treat­ment. Phys­i­cal ther­a­py, exer­cis­es and reha­bil­i­ta­tion may be includ­ed in a sched­ule for return to nor­mal activities.