So I fell yesterday and when I woke up today I saw my big toe was bruised. I went to a walk in clinic where they took X rays. the physician said the toe didn’t look broken, but when I checked the radiology report online it said the following:
Nondisplaced fracture along the lateral aspect of the first distal
phalanx with likely intra-articular extension. Negative for
radiopaque foreign bodies. Mild soft tissue swelling overlying the
dorsum of the foot. Normal bone mineralization. Achilles heel spurs.
Mild degenerative changes in the midfoot.
What exactly am I supposed to do now? The physician I saw said it wasn’t broken and sent me home.
I’m assuming “nondisplaced fracture” means the bone was cracked but not into two separate pieces? If so, your shoe and other toes will act as a cast and keep the toe straight while it heals.
I’ve broken multiple toes over the years, and pretty much every finger, some multiple times. I used to put a splint on my broken fingers, but I don’t anymore; mostly a pain in the ass dealing with that taped-on piece of metal. Now I just avoid doing anything that makes the broken appendage hurt. Eventually it heals. Your toe will too.
I suffered a simple fracture of my second toe (which is a bit longer than my big toe) about 15 years ago, when I stubbed it badly against a piece of furniture. Guidance was to tape it to its neighboring toe with medical tape for a few weeks, for support, and to keep it straight.
I wonder if Weird Al reads these boards. This would make a good lyric for a cover of “The impression that I get” by the mighty, mighty bosstones
Never had to tape a broken toe
But I know someone who has
Which makes me wonder if I could
It makes me wonder if I’ve
Never had to tape a broken toe
And I’m glad I haven’t yet
Because I’m sure it isn’t good
That’s the impression that I get
Chiming in to agree with everyone upthread. Did I break my toe a while ago? I think I did (I dropped a very heavy sandwich board on it). But, I knew that the medical establishment doesn’t/can’t do much for a broken toe, so I followed advice given here, favored it for a while, and eventually it was as good as new.
No idea if it was actually broken or not, but all’s well that ends well.
@Wesley_Clark
The big toe is essential for balance and a fracture here can cause more complications than one of the smaller toes. It is reasonable to tape the littler toes if the fracture is undisplaced. But the big toe (often called the great toe. Why? Dunno.) really needs to heal properly. To avoid complications, “great toe” fractures are usually treated more aggressively, such as with a walking boot and sometimes with a plate to reduce putting weight on the toes. If insurance or income makes it feasible, it would be worth getting it looked at again, re-X-rayed, and consider doing more than just taping it to another toe, which might or might not work. I would get it looked at again, especially if joint involvement was suspected.
MANAGEMENT: GREAT TOE FRACTURES
Management is influenced by the severity of the injury and the patient’s activity level. Physicians should consider referring patients with fractures of the great toe that have any degree of displacement, angulation, or rotational deformity 6,24(Figure 12).
Great toe fractures are generally treated with a short leg walking cast with a toe plate*(Figure 13* 11) that extends past the great toe or with a short leg walking boot for two to three weeks.6 After this time, and in the absence of significant symptoms, the patient can progress to buddy taping and use of a rigid-sole shoe for three to four weeks.6,23,24Range-of-motion exercises can generally be initiated at four weeks. Repeat radiography is indicated and should be obtained one week post-fracture if there was intra-articular involvement or if a reduction was required.*
Thank you @Dr_Paprika I’m going to go back to a different urgent care clinic tomorrow (in the same health network, so they will already have my X-rays and radiology report on record) and speak to a different doctor. I was worried because I know the big toe is involved in balance and walking more than the other toes.
I consider McRae’s book Practical Fracture Treatment fairly definitive, and they give a number of options depending on location and symptoms. It is common for people to drop heavy items on their big toe, sometimes breaking the distal phalanx into pieces, and with a fracture extending into the joint. The doctor checks the circulation and nerves, makes sure the nail looks okay and does not have subungal blood that needs draining, or nail removal, then looks at the fracture and toe ligaments.
Buddy taping for 3-4 weeks might be an option if the toe is asymptomatic, but can cause increased pain and is not always suitable. Walking casts with toe platform or cutout tends to have fewer symptoms. Given the fracture was missed, it is reasonable to get another opinion and possibly another X-ray and more aggressive treatment. They can make sure things have not worsened and make sure you have appropriate follow-up. I’m not saying taping never works for closed big toe fractures, but it is less reliable than for smaller toes. You really want this to heal properly with minimal discomfort. Best of luck!
Ditto when I broke my 4th toe, a couple years back. They did have me wear a surgical boot for a couple months, to reduce the risk of it getting flexed in a bad way.
That’s definitely changed in the last 35 years or so. When I broke my big toe in high school, my doctor offered to cut it off (facetiously), but otherwise just said what @Dinsdale did- take it easy for a couple of months.
This is correct.Tape it to the nearest toe, try not to walk on that foot very much. May not grow back straight but there is not a lot a doctor can do with a broken toe except do the same thing.
I broke toes a couple of times I think, never got X-rays to tell for sure. Time and injuries have taught me it’s a good idea to always get it checked and follow advice for proper healing. Injuries that don’t heal right accrue interest over time and eventually the bill will come due.
