Are you eager to learn how to recognise toe fractures? Do you want to know how they are treated and the recovery timeline.? You are in the right place!
In this article I base on my knowledge as a diagnostic radiographer, and I also summarise the key findings from scientific studies on the treatment and recovery of toe fractures.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: April 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
Summary
Fractures of the toes are one of the most common lower extremity fractures I see in x-ray daily. Patients come to us claiming to have different symptoms after direct toe injury. They always have questions about treatment and recovery.
Before delving into your questions about toe fractures let’s first look at a little bit of the anatomy.
▶️Anatomy of the toe
Your toes are composed of phalange bones. They are named as the distal, middle, and proximal phalanx apart from the big toe that has two phalanges.
You also have flexor and extensor tendons inserted at the proximal portions of the middle and distal phalanges. These tendons may avulse small fragments of bone from the phalanges.
So, when you have an injury on your toes these bones and tendons are more likely to fracture.
▶️What are the different types of toe fractures and causes?
Toe fractures are commonly divided into two types namely.
1️⃣Traumatic fracture that may occur when there is a direct impact of your toes on a hard surface.
2️⃣Stress fractures are tiny hairline cracks in the toes that most commonly occur due to repeated stress.
usually toe injuries are caused by dropping something on a foot or stubbing a toe.
▶️How do you know if you fractured your toe and not just bruised it?
Most patient who come into x-ray after toe injury usually are complaining of the following symptoms:
⭕Throbbing Pain that worsens with a dependent position.
⭕Swelling and tender around the phalanges of one or more toes.
⭕Change in skin colour from bruising!
⭕Bleeding under the skin/nail!
⭕Difficult in walking or bearing weight on the foot.
⭕Deformation of the toe.
⚠️Caution⚠️! All these symptoms may not necessarily be present at the same time. Similar symptoms can originate from other issues such as tendons damage at the proximal portions.
Having these symptoms cannot determine if you have really fractured your toe or just bruised it. When you go to the doctor, he will do a clinical examination.
By this he will look for capillary refill which is detecting changes in blood flow to your toes, the skin will be checked for open wounds or bleeding under the nail, any deformity and swelling.
Then you will be sent to x-ray for imaging to determine if you have fractured any bones or a bruise.
Usually, x-rays are enough to determine if you have had a fracture or bruise.
⚠️Caution⚠️! A bruise on the bone can feel like a break but you will be able to tell before x-ray that you might have a fracture if the painful toe is pointing in a different direction than your other toes.
stress fractures of the toes are usually not seen until several weeks later when it has started to heal. And a type of healing bone called callus appears around the fracture site as projected in the image below.
Image: stress fracture showing a healing bone called callus
MRI scan is good for showing a stress fracture if it is not seen on x-ray, it will show changes in the bone.
▶️Treatment options for injured toes
Management and treatment are determined by the location of the fracture and its effect on balance and weight bearing.
The primary goals of treating toe fractures are to re-establish and maintain alignment so that you can regain a full range of motion to help prevent future complications.
The most fractured toes I have x-rayed among the five toes are the big toe and the little toe.
Big toe fractures are more common than other toe fractures because they are more used for weight-bearing and balance motion while standing.
Most treatments I have seen for a toe fracture are non-surgical. This means that you may not need surgery to treat your fracture.
Surgical treatment will only be considered when the fracture is completely displaced, unstable and there is a risk of poor healing.
In an analysis of 339 toe fractures, 95% involved less than 2 mm of displacement and all fractures were managed conservatively with good outcomes and none of them needed surgery. (Van,2011)
▶️Great toe treatment options
If your big toe is fractured it will either dislocate, displaced intra-articular or become unstable.
Great toe fractures are treated with a cast with a toe plate for two to three weeks or short leg walking boot, then a rigid-sole shoe for an additional three to four weeks depending on the fracture level.
Image of a short leg walking cast with a toe plate and a walking boot and rigid-sole shoe
▶️Treatment options of lesser toes fractures
Management will depend on how your fracture is displaced.
For displaced fractures your doctor will be numbing the toe with ice or a digital block before he manipulates the bone fragments into proper position.
In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment.
You will be given a follow-up in seven to 10 days after reduction to check alignment and any swelling.
With non-displaced fractures a buddy taping will be applied, and the preferred technique is to buddy tape the affected toe to an adjacent toe.
▶️To answer your question: Do you wear a boot for a fractured toe?
This will depend on your symptoms, most patients I see are advised to wear a rigid soled shoe or moon boot for approximately 3 weeks or more before transitioning into roomy, supportive and enclosed footwear, such as runners.
Until Initial follow-up that takes place within one to two weeks then you will be advised to take it off or not depending on how the fracture is healing.
▶️How long does it take for a toe fracture to heal?
Here are some timelines that I have observed in patients and scientific studies (nhs).
| Stage | Recovery timelines |
| Pain & swelling | A few days to a week |
| Buddy-taped off | 2 to 4 weeks your toe must have healed. |
| Stop wearing a walking boot | 2 to 4 weeks or more depending on your injury |
| Toenail bruise | Will go away in time with nail growth |
| Stop using crutches | When you feel you can weight bear without pain |
| Complete healing | Can take 4 to 6 weeks (Metatarsal fractures can take 6-8 weeks. |
▶️How can I speed up the healing of a broken toe?
Toe injuries heal quicker if you follow your doctors’ instructions. There is no quick way of speeding up healing. Your body has a natural way of healing bone fractures.
There are a few things you can try to do to help with your quick recovery.
Weight-bearing Walking!
♾️In the first few weeks avoid weight-bearing activities, you can partially weight-bear while walking if you can this will help with less pressure on the fracture toe.
♾️Walking on the foot is encouraged, but only as pain allows.
♾️Try to rest and protect your toe. Do not walk on it until you can do so without too much pain.
♾️If the doctor has told you to use crutches, use them as instructed.
♾️You can use ice to reduce pain, inflammation and swelling if you find it comfortable.
♾️Take pain-relieving medications prescribed by your doctor.
♾️Smoking will slow healing; you can minimise the healing phase.
♾️You can elevate the affected foot to help reduce swelling.
▶️Do you need physical therapy to help with the healing process?
I have not seen people having physical therapy for toe fractures. If you can follow the home remedies, you will be able to return to your normal activities as quickly as possible, within a few weeks.
Unless you have got other associated fractures then you might need physical therapy.
▶️What makes a broken toe worse?
One of the reasons why you should get your toe injury checked is to try to avoid infection.
If the skin of your toe was cut at the time of injury, you have an increased risk of developing an infection.
Especially if you have certain conditions such as diabetes, rheumatoid arthritis and any immune system conditions.
So, get it checked even when you think it is not fracture
▶️Why does my broken toe hurt so much at night?
The science behind pain increasing in the night has been attributed to this apotheosis.
During the day, the various activities and hustle-bustle of life act as a distraction away from pain, so the pain perception is lesser.
At night, when you are sleeping, there are no such distractions, so the awareness or perception of pain heightens.
I could not find sources supporting this apotheosis, you can do your own research, your ideas are welcome in the comment section.
I have come to the end of this article ,I hope I have answered some of your questions about toe fractures.
I wish you a quick recovery.🙋
📚SOURCES:
Bica D, Sprouse RA, Armen J. Diagnosis and Management of Common Foot Fractures. Am Fam Physician. 2016 Feb 1;93(3):183-91. PMID: 26926612.
Eiff MP, Hatch R, Calmbach WL. Fracture Management for Primary Care. 2nd ed. Philadelphia, Pa.: Saunders; 2003: 306–330.
Schnaue-Constantouris EM, Birrer RB, Grisafi PJ, Dellacorte MP. Digital foot trauma: emergency diagnosis and treatment. J Emerg Med. 2002;22:163-70.
Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003 Dec 15;68(12):2413-8. PMID: 14705761.
Image : M. Tang, K.C. Hui, The effect of tendons on foot skin deformation, Computer-Aided Design, Volume 39, Issue 7,2007,Pages 583-597,ISSN 0010-4485,https://doi.org/10.1016/j.cad.2007.01.013. (https://www.sciencedirect.com/science/article/pii/S0010448507000401)