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If you have stubbed or dropped something on your toe, you may be wondering whether your toe is broken or just bruised. You may also wonder whether you should visit your doctor about a broken toe. Broken toes should be properly addressed and not ignored. Toe fractures account for approximately 8% to 9% of fractures (1).
In this article, we’ll discuss everything you need to know about broken toes, as well as solutions on what you can do about it.
Let’s dive in…
Anatomy of Toes
The big toe has two bones. The second-fifth toes have 3 bones in them. Occasionally, in the 5th toe, the last two bones may be fused in some people. Each toe has tendon attachments on the top of the toes called the “extensor tendons” that help lift the toes when walking.
On the bottom of the toes, there are the “flexor tendons” that help with the downward motion of the toes. There are also other tendons that attach to the sides of the toes that are responsible for spreading the toes apart. There are also ligaments present in the toes that support the joints.
All of this information is important when it comes to treating toe fractures!
This is because when your toe is broken, it may also be dislocated, or may involve tendon injury. This will all impact the way your toe may heal in the future.
How Do You Know if Your Toe Is Broken or Not?
Most toe fractures are caused by an axial force (e.g., a stubbed toe) or a crushing injury (e.g., from a falling object) (2).
However, fractures can happen due to overextension or flexion of the toe joints during activities.
Some of the signs of a broken toe include:
- Swelling/Bruising: When you break your toe, you may notice immediate swelling and bruising due to damage to the blood vessels in the toe. Your toe may be blue or purple.
- Subungual hematoma: A subungual hematoma occurs with an injury to the toe, causing blood to build up underneath the toenail. The presence of a subungual hematoma can indicate that the toe may be broken. To learn everything you need to know about black toenails, check out this supplemental post!
- Pain: You may notice dull, achy pain in the broken toe. You may also feel some sharp and tingling pain due to aggravation of the nerves in the toe.
- Alignment: You may notice that the alignment of your toe is not right. If your toe is dislocated, the bones in the toes may be shifted or even rotated. This can make it difficult for you to put on your shoes. Check your toenail. Is it facing in the correct upward position? If not, the bone underneath may be broken.
- Difficulty bending the toes: Although you can still wiggle and slightly bend your toe when it’s broken, you may have difficulty doing so. If you break your toe, you may have bruised your tendons, making it difficult to move your toe.
Should You See a Doctor for a Broken Toe?
You should see a foot doctor for a broken toe. Your doctor will examine your toe, and get x-rays to determine where the break is, and if there is any displacement of the fracture.
Displacement is when there is a gap between the fracture fragments. Your doctor will also check the alignment of your toe to determine whether the fracture needs to be reduced. Your doctor will also check if there is joint involvement, as this can impact treatment.
Treatment for Broken Toes
Non-displaced Toe Fracture
If you have broken your toe and the fracture is nondisplaced, your doctor may suggest you buddy tape your broken toe to the adjacent toe. Non-displaced fractures indicate that the toe is broken but in a somewhat proper position that doesn’t require any reduction or surgery. Fracture healing can take 4-6 weeks minimum.
To buddy tape, a toe, place cotton or gauze between the broken toe and the adjacent toe. You can use adhesive cloth tape or even Coban to secure the toes together. I prefer using Coban due to its comfort and also its ability to reduce swelling.
Check out this video below by Richard Blake on how to properly buddy tape a toe. Make sure you are not taping the tip of the toes together, as this can cause your broken toe to rotate.
Your doctor will also suggest that you stay weight-bearing in a surgical cast shoe for 3-4 weeks to prevent flexion and extension of the toes. You can get one on Amazon. If you move the toes too much, a non-displaced fracture can turn into a displaced fracture quickly. If your fracture fragments shift, you may need surgery.
If your fracture extends into the joint and encompasses greater than 25% of the joint surface on x-ray, you may develop arthritis in the joint (2).
In addition to staying in a walking cast shoe, make sure you rest and ice your foot. Icing should be done for no more than 20 minutes every hour. Elevate the foot on 2 pillows to keep the swelling down in your toes.
Displaced Toe Fractures/Dislocations
If your fracture fragments are displaced or “shifted” your fracture may need to be reduced. Oftentimes, this can be done in your doctor’s office under local anesthesia. Your doctor will inject local anesthesia into your toe to numb your toe. This will only be temporarily uncomfortable. Your doctor will then pull on your toe and reduce it back to its proper alignment.
He/she will then obtain x-rays to confirm that it is reduced and splint it in the appropriate position. You will need to walk in a surgical cast shoe for 3-4 weeks.
Occasionally, if the toe fracture is not reducible, you may need surgery. This is especially true with a big toe fracture. The big toe helps with push-off and balance. The extensor hallucis longus tendon that courses on the top of the big toe is incredibly important in lifting the toe when you walk.
If there is damage to the tendon with displacement of the fracture fragments, surgery may be warranted. Soft tissue structures (tendons and ligaments) can be caught between the fracture fragments. This can make a closed reduction in the office setting difficult.
In these cases, your doctor will suggest an open reduction of internal fixation of the broken toe. This will need to be done in the operating room under anesthesia. Your doctor will perform surgery to fix the toe fracture and secure it using a K-wire or mini-screws. A Kirschner wire (K-wire) is a pin that is used to splint the fracture in the correct position.
You will need to remain in a cast boot for a minimum of 4-6 weeks after the surgery.
Open Fractures of the Toes
If you sustain a crush injury to the toe that results in a puncture wound or laceration at or near the fracture site, along with a break in the bone, it is considered an “open fracture”. In this case, your doctor will look at your x-ray to assess the damage. He/she will then put you on antibiotics.
Depending on the severity of the injury, your doctor may recommend irrigating and cleaning the wound in the operating room under anesthesia. The fracture will need to be repaired as well.
Diligent wound care will be needed post-operatively to make sure the wound heals appropriately.
Open fractures can place you at a higher risk of developing osteomyelitis (bone infection). This should be taken seriously as bone infections can result in the prolonged need for IV antibiotics and even amputation.
To read more about bone infections in detail, check out this supplemental post Diabetic Osteomyelitis (Bone Infection)- A Helpful Guide.
How Long Does a Broken Toe Take To Heal?
Depending on the fracture and the toe involved, it can take anywhere from 4 weeks to 8 weeks for a broken toe to heal. Healing may take longer if the fracture is comminuted (multiple fragments), becomes displaced, and if you have a positive smoking history. Smoking can slow down bone healing.
Should a Broken Toe Still Hurt 1 Month After?
Broken toes can still hurt during the healing process. Since the actual break takes 4-8 weeks to repair itself, the toe will still hurt. You may notice persisting dull, achy pain. If the broken toe goes untreated, it may hurt for months or even years after the injury due to malalignment and arthritis.
How Do You Know if a Broken Toe Is Healed?
If your pain has gone away, it is a good indicator that your toe has healed or is near healed. The best way to check if a broken toe is healed is with an x-ray. You will need to obtain x-rays every 4 weeks to see if the bone has healed. X-rays are also important to ensure that the fracture fragments have not shifted during the healing process.
What Activities Can You Do With a Broken Toe?
When you break a toe, make sure that you rest, and avoid high-impact activities such as running for at least a month. Remember, a broken toe needs to heal, and activities that involve a lot of pressure on your toes can damage your toes further.
If approved by your doctor, you may be able to perform low-impact activities such as swimming and walking. Leisure biking may also be okay as long as you are buddy-taping your broken toe and wearing shoes with a stiff bottom. This should only be done if you have a mild non-displaced fracture, and the fracture is not comminuted.
Can You Work With a Broken Toe?
Returning to work with a broken toe is dependent on your job. If you have a sit-down job, you can return to work with a broken toe. It would be best to elevate the foot while seated to help reduce swelling.
If you have a demanding job that requires you to walk long distances, you will need to speak to your doctor about restrictions and the need for time off work for a few weeks. This is especially true if you have had surgery and are taking pain medications during the recovery process. You should not drive while taking narcotics.
Conclusion
As you can see, a broken toe should not be taken lightly. The treatment for broken toes depends on the toes involved, the type of fracture, as well as whether it is a closed or open fracture. If you suspect that you may have broken your toe, it’s important to contact your foot doctor to have it examined and treated.
Have you broken your toe before? How long did it take to heal? I would love to hear your thoughts! Leave a comment below!
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Related article: Toenail Is Falling Off: Understanding the Causes & Treatments of Toenail Loss
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References
- Eiff, M. Patrice. Fracture Management for Primary Care and Emergency Medicine (Fourth ed.). (2021)
- Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003 Dec 15;68(12):2413-8.https://pubmed.ncbi.nlm.nih.gov/14705761/
- Van Vliet-Koppert, S. T., Cakir, H., Van Lieshout, E. M., De Vries, M. R., Van Der Elst, M., & Schepers, T. (2011). Demographics and functional outcome of toe fractures. The Journal of foot and ankle surgery, 50(3), 307-310.https://www.sciencedirect.com/science/article/abs/pii/S1067251611000330
- York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. Curr Rev Musculoskelet Med. 2017 Mar;10(1):104-112.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344861/
- Yang IB, Sun KK, Sha WL, Yu KS, Chow YY. Interphalangeal dislocation of toes: a retrospective case series and review of the literature. J Foot Ankle Surg. 2011 Sep-Oct;50(5):580-4. https://pubmed.ncbi.nlm.nih.gov/21621431/
- Laird RC. Acute forefoot and midfoot injuries. Clin Podiatr Med Surg. 2015 Apr;32(2):231-8.https://pubmed.ncbi.nlm.nih.gov/25804712/#:~:text=Forefoot%20and%20midfoot%20injuries%20in,joint%20can%20be%20very%20debilitating.
- Baker JR, Glover JP, McEneaney PA. Percutaneous fixation of forefoot, midfoot, hindfoot, and ankle fracture dislocations. Clin Podiatr Med Surg. 2008 Oct;25(4):691-719, x.https://pubmed.ncbi.nlm.nih.gov/18722907/
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