THIS LITTLE PIGGY

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Some people will do anything to avoid going to the doctor. While I admire the general Stoicism and true grit, as a medical professional I do advise that you never take chances with your health. It’s too precious. So if you have any sort of injury more serious than a chipped nail, please see your doctor!

An injury which people frequently downplay is a broken toe, or an injured toe which may be broken. It’s not true that if you can walk on it, it’s not broken, by the way.

 

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Of the 26 bones in the foot, 19 are toe-bones (phalanges) and metatarsal bones (the long bones in the midfoot). Breaks in these bones are divided into two categories: traumatic fractures and stress fractures. Traumatic fractures are also called acute fractures. These are caused by a direct blow or impact. People commonly do this by stubbing their toe into something really hard—a stainless steel table-leg, for example. You can also do this by jumping off something and landing “wrong”. Let me add that I don’t recommend jumping off things, period! You are not a cat.

 

 

Kids often injure their feet this way, of course. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the position of the bone is changed, and the toe may be visibly out of alignment. The displaced toe will look crooked. A non-displaced fracture may be easier to ignore, because often there is no visible problem, other than perhaps a bit of bruising or swelling which does generally go away on its own.

Don’t ignore it.

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A patient of mine experienced a non-displaced metatarsal fracture—breaking, but not displacing the middle toe on her left foot—by dropping down off a ladder onto a beach, while wearing Uggs. This was years ago. She lived in a remote area of Northern California and didn’t get it treated (San Francisco was a three-hour drive away), and she says that the toe still hurts, to this day. True, the broken toe healed within several weeks, but medical care at the time would have prevented her chronic, though minor, pain.

The other kind of fracture is a stress-fracture, which is a tiny hairline break usually caused by repetitive stress on the toes, such as upping your mileage when you’re training as a runner. These fractures may also be caused by abnormal foot structure, by osteoporosis, and by cruel shoes (i.e. narrow-toe stiletto pumps!).

Stress fractures generally don’t bruise, although they may produce swelling. A common symptom is persistent pain in the area.

As for treatment, sometimes rest is all that’s needed for a fracture of the toe to resolve itself. In other cases, immobilization, using a splint taping the toe to an adjoining toe—may be needed. In extreme cases, surgery is (rarely) required.

As always, self-diagnosis is not wise. If left untreated, the bones will eventually knit back together. Our bodies will do anything they can to heal themselves! However, an improperly treated fracture can lead to loss of mobility in the foot, arthritis, long-term deformity of the foot, and, as is the case with my friend who jumped off the ladder, nagging pain in the injured toe.

Why chance it? Your foot and ankle surgeon can analyze the problem and recommend corrective treatment in literally a few minutes. Your feet are so essential to an active life, so don’t take them for granted.

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