A broken (fractured) toe is a fairly common injury which usually needs no specific treatment. It is most often caused by dropping a heavy object on to the foot.
What causes a broken toe?
A broken (fractured) toe is an injury normally caused by impact, usually from dropping a heavy object on the toe or stubbing the toe hard. Generally it takes quite a lot of force to break a bone. However, toe bones are more vulnerable because they are small bones and because they are on the edge of the body.
Occasionally, broken toes may occur in association with other complex injuries, such as after a fall from height on to the feet, or because of a road traffic accident.
What are the symptoms of a broken toe?
Bone breakage (fracture) in people with normal working nerves is a very painful injury. Broken bones bleed, so the area will swell fairly quickly. It will eventually bruise as the blood tracks through to the skin. There may be blood visible beneath the toenail.
In addition, the break may be displaced, or may run through the toe joint. In this case the toe will look misshapen.
It's painful to walk on a broken toe. This is particularly the case if it is the big toe which is broken, as this toe takes more of our weight when we walk.
It can be difficult to be certain that your toe is broken, as sprains and strains and dislocations also cause pain and tenderness. Deformity of the toe usually means break or dislocation; severe swelling or bruising is suggestive of a break but often the only way to be sure is with an X-ray.
Do I need to see a doctor if I have broken my toe?
You don't always need to see a doctor for a broken (fractured) toe. You can manage this condition very safely yourself as long as the broken toe isn't crooked or out of line and there is no skin wound over or near the fracture.
You should, however, see a doctor for your broken toe if:
- The pain becomes worse and isn't relieved by normal painkillers.
- The swelling and bruising don't start to improve in a few days.
- There is an open wound associated with the break.
- You have a medical condition that may affect your healing - for example, diabetes, heart failure, peripheral arterial disease, HIV.
- You are taking oral steroids.
You should go to an accident and emergency department if:
- The toe goes numb or tingly. This suggests pressure on, or damage to, the nerves to the toe (which run up the side of the toe, one on each side).
- The skin on the toes has turned blue (other than bruising) or grey and is cold to the touch when the other toes are not.
- The toe is bent at an angle or with an open wound.
- The toe is your big toe.
- You have more than one fractured toe.
- The injured person is a child: children may need a special boot for walking and may need a booster of their tetanus and diphtheria immunisation. It can be difficult to be certain that the child's toe is not misaligned without an X-ray.
- The accident in which you damaged your toe was severe - for example, a fall from a height or a road traffic accident (you may have other injuries).
How do I look after my broken toe?
If your broken (fractured) toe is not displaced, it is not your big toe and the skin is not broken then you may be able to manage it at home yourself, as long as none of the conditions above apply. Rest, ice and elevation are recommended for initial management to help reduced bruising, swelling and pain, and therefore shorten recovery time.
- Rest: means not putting excessive weight on the toe and not standing for too long.
- Ice: beyond 72 hours ice is no longer beneficial. Hold an ice pack to the toe for 15-20 minutes every one to two hours for the first couple of days.
- Elevation: this is helpful for as long as the toe is swollen but particularly for the first 24 hours.
- Padding: for the smaller four toes, put padding between the toe and the one next to it and tape them together. The healthy toe will act as a splint.
- Pain relief: take over-the-counter painkillers such as paracetamol or ibuprofen to relieve the pain. Ibuprofen gel applied to the toe may be helpful if the skin isn't broken.
- Protection: wear sturdy shoes that don't squash or bend the toe.
You can begin normal activity once the swelling has gone down and you're able to wear a protective shoe comfortably.
How is a broken big toe treated?
A broken (fractured) big toe may be put in a cast to support it, as it takes much more of your weight than the other toes and is also needed for balance.
The big toe is more likely than the smaller toes to need surgery in order to heal well enough to be as strong as it was before you broke it. Even if surgery is not required, you may be given crutches so you can walk without putting weight on the toe.
What treatment would I get for a badly broken toe?
If there is a lot of blood under the nail this may put pressure on the nail and make it very painful. Your accident and emergency department may make a small hole in the nail with a heated needle in order to allow the blood to escape, or they might remove the nail. However, they will be cautious if there is a break (fracture) beneath the nail, as if the nail is intact it will protect the break beneath from infection.
If the skin is broken then you may need antibiotic medication to protect you against infection in the fracture, which would interfere with healing and could spread further into the foot.
If your toe is crooked, particularly if the fracture is through one of the toe joints, your toe may need to be put back into line and held with metal pins. You will be given local anaesthetic injections to numb the area - normally one on each side of the toe at the base. Doctors may then be able to realign the skin without surgery.
If pinning is needed this can be done in several ways:
- With a metal wire (called a K-wire) which is inserted through the tip of the toe, down its length. K-wires are smooth and slim. They are inserted with a special drilling device, usually under anaesthetic. The wire can be pulled out fairly painlessly by the surgeon once the bones have healed, usually 3-4 weeks later.
- With internal wiring or metal plates which are not visible from the outside and which stay permanently in place.
- External fixation with pins and bars may be needed for complicated toe breaks.
A plaster cast might then be put over the foot to keep everything firmly in place whilst it all heals. You might need crutches or a special boot.
What are the possible complications of broken toes?
Well-healed toe breaks (fractures) usually cause no ongoing problems. The possible complications of broken toes, which are more likely to apply to severe breaks, include:
- Failed healing of the bones: this can either mean the bones heal in a crooked state or that they don't heal together at all. In either case further surgery may be needed.
- Bone infection: this is called osteomyelitis and can be very persistent. A long course of antibiotics or further surgery may be needed.
- Toe stiffness is a common consequence of a broken toe, particularly if the joint was involved. Joints anywhere in the body which have had blood in them have a tendency to become stiffer. Physiotherapy exercises may help.
- Pain: it is quite common to have occasional aches and pains in a bone that has been broken, particularly in cold weather or after heavy use. More severe pain suggests further treatment is needed.
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Further reading & references
- Hatch RL, Hacking S; Evaluation and management of toe fractures. Am Fam Physician. 2003 Dec 15 68(12):2413-8.
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