The toes are comprised of small bones (called phalanges), which are susceptible to breaking when exposed to blunt trauma. Most broken toes are called “stress” or “hairline” fractures, which means a small surface crack that’s not serious enough to misalign the bones or break the skin’s surface. Less commonly, a toe can be crushed such that the bones are completely shattered (a comminuted fracture) or fractured such that the bones radically misalign and stick out through the skin (an open compound fracture). Understanding the severity of your toe injury is crucial because it determines the type of treatment protocols you should follow.
A broken toe is a common injury that most often occurs when you drop something on your foot or stub your toe.
In most cases, a broken toe can be immobilized by taping it to a neighboring toe. But if the fracture is severe — particularly if it involves your big toe — you may need a cast or even surgery to ensure that your broken toe heals properly.
Most broken toes heal well, usually within four to six weeks. Less commonly, depending on the precise location and severity of the injury, a broken toe may become infected or be more vulnerable to osteoarthritis in the future.
Small hairline (stress) fractures, bone chips and contusions are not considered serious medical conditions, but severely crushed toes or displaced compound fractures often require surgical intervention, especially if the big toe is involved. Medical specialists such as an orthopedist (bone and joint specialist) or physiatrist (muscle and bone specialist) or a podiatrist can better assess the seriousness of your fracture and recommend appropriate treatment. Broken toes can sometimes be related to diseases and conditions that affect and weaken bone, such as bone cancer, bone infections, osteoporosis or complications related to diabetes, so the medical specialists need to consider these when examining your toe.
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.
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.
Remember that the best way to stop yourself from breaking toes is to act with prevention. Be cautious while moving barefoot, especially in dimly lit circumstances. Wearing protective shoes and other layers such as corrective socks can help prevent or reduce potential toe injuries.