Patient Education

Toe and Metatarsal Fractures

Description

Let’s have a little story, shall we? Gordon was stumbling around his bedroom one night (with the light off, for fear he would wake his slumbering wife) when his pinky toe caught on the corner of a dresser and snapped. Gordon crumpled in pain, yelled like a soccer fan after a big win, and woke up his wife anyway.

How about another story? Helen decided to run a marathon. She thought to herself, “I jog several miles a day anyway, and how much harder could twenty be than five?” The first day she started training, she pushed herself to ten miles and barely made it home. The second day, she did twelve and nearly collapsed from exhaustion. After a week of pushing herself hard, she went out again, only to discover after about one mile that her foot hurt so much she couldn’t even walk back to her house. She called her neighbor to come and get her. Resting with her foot propped up seemed to help, so she tried running again the next day, only to be gobsmacked by the same pain.

And another? When she was hauling her twenty-third box to her beat-up truck, Paula wished she had called her brothers to help her move into her new dorm room. Unfortunately, she was all by herself when she lifted a box of books, took a couple of steps, and lost her grip. The box plummeted down to the ground and landed squarely on top of her big toe.

These stories may be somewhat…unhappy…but they do help to illustrate a few ways you can break your toes or metatarsals. Basically, breaks in these bones (they make up over half the bones of your foot, by the way) can happen in a couple of different ways. You can have a traumatic fracture, which is a break from a specific event, like dropping a box of books on your foot or catching your toe on a piece of furniture, or a stress fracture, which is when tiny cracks in your bones develop over time. Sometimes stress fractures are a result of a change in your exercise routine (like Helen’s story), or they can develop over long periods of time, often due to structural abnormalities in the foot, a condition like osteoporosis, or wearing improper shoes. (And we’re not talking ‘improper’ as in the shoe doesn’t covers your foot modestly. We’re talking about shoes that don’t support your foot adequately, or cause additional stress to your foot.)

Bone breaks come in many different varieties. They can be open or closed fractures (open fractures mean the bone has broken through the skin; with closed fractures, your skin remains intact). Bones can also be displaced (moved from their proper position), or stable (the bones are still in the correct place). You may even have an avulsion fracture when something (like a strained tendon) pulls a piece off the main part of the bone.

Some people may believe that doctors can’t do anything for broken toes, but the truth is that there are treatments available. And some toe breaks may even require surgery. Staying away from the podiatrist’s office when you have an injury to your foot can lead to serious complications, like deformities, arthritis, chronic pain, and failure of your bone to heal. So, don’t just ignore your injured digit: see a podiatrist about it as soon as possible.

Symptoms

Traumatic breaking of your bone might be pretty obvious to you. Sometimes people feel or hear a crack when the break happens. Broken bones are also pretty painful, although the pain tends to be pinpointed to the location of the break. This pain may go away after a few hours, or subside somewhat. You may also notice swelling in the injured area, as well as bruising, and your toe or foot may appear crooked or abnormal.

Stress fractures may be a bit less obvious. They’ll be painful, but the pain will likely subside with rest, then return again when you put weight on your foot or resume activity. The area around the fracture may swell, although you probably won’t see any bruising, and you’ll likely have pinpoint pain there as well.

Diagnosis

Your podiatrist has heard many, many stories about the breaking of bones, but he’ll want to hear your story as well. Whether your break happened suddenly like Paula’s or Gordon’s, or over several days (like Helen’s) or months, your podiatrist will want to hear about it all. Give him or her information about where your pain is located, how long it’s been going on, and any other symptoms you’ve noticed (like swelling or bruising). Also let your podiatrist know if anything seems to help the pain or make it worse.

To get to the heart of your story, your podiatrist will probably want to take a look at your foot, both outside and inside. X-rays are often helpful for traumatic breaks, although stress fractures tend not to show up until after they’ve already started healing (usually after two or three weeks). Your podiatrist may be able to determine you have a stress fracture just based on your examination and medical history, although he or she may also choose to order a bone scan to find out for sure.

Treatment

Stress fractures of the metatarsals are often treated conservatively with rest and immobilization of the bone. You’ll want to avoid doing the activity that caused the stress fracture in the first place. (For instance, Helen will want to take a break from marathon training). Your podiatrist may have you wear a stiff-soled shoe or a cast to allow your bones to heal. You may also need to use crutches or a wheelchair for a while to avoid putting stress on your healing bone.

Fractures of your toes can be treated using a variety of methods. Rest will likely be helpful (in other words, try to stay off your feet as much as you can), and stiff-soled shoes can protect the broken bones and keep things aligned. Your podiatrist may also put a splint on your broken toe, or may buddy-tape the broken toe to an uninjured toe, with some gauze in between to absorb moisture. (You’ll need to change the gauze and re-tape from time to time as needed.)

Surgery is sometimes necessary, particularly if the fracture is in a place that doesn’t heal very well, is badly displaced (has moved from its proper location), or if it fails to respond adequately to conservative treatment. Your surgeon may use pins, screws and plates to keep the pieces of bone in place while they heal.

There are many stories about broken bones, and while they’re not fun when they happen, you’ve got to admit that they make amusing anecdotes (when told a long time after the event itself, of course). But really, the person who decides whether your story has a happy or unhappy ending is you. Be sure to follow your podiatrist’s instructions for the best possible outcome for your injury.