How toes break
Each finger, except the thumb, consists of three small bones - phalanges, and the thumb consists of two, but more massive ones. Most often, the little finger and thumb are affected: the little finger because of its extreme position, the big finger because of the load. A typical mechanism is direct: hitting furniture or a threshold, falling a heavy object, crushing. The indirect mechanism is associated with tucking the foot, when the toe remains fixed and the foot continues to move. Separately, stress fractures are identified, which develop gradually in runners and dancers without a single noticeable injury.
- Hitting your finger on a hard object
- Heavy object falling on foot
- Tuck in the foot with a fixed toe
- Foot pressing
- Repetitive stress fracture
- Fracture due to osteoporosis with minimal trauma
Symptoms: fracture or bruise
Both a bruise and a fracture cause pain, swelling and bruising, so they cannot be distinguished by appearance alone. Still, there are clues: with a fracture, the pain is sharp, point-like, intensifies with axial pressure on the tip of the finger, swelling spreads to adjacent fingers and the back of the foot, and the bruise eventually goes down the foot. Deformation, shortening, unusual position of the finger or a crunching sensation almost confirms a fracture. With a bruise, the pain gradually decreases after a couple of days; with a fracture, it lasts longer and interferes with support.
- Sharp pain immediately after injury
- Swelling and blueness of the toe and adjacent areas of the foot
- Pain when pressing along the axis of the fingertip
- Deformation or unnatural position of the finger
- Bleeding under the nail
- Lameness and pain when pushing off
Diagnostics
The main method is an x-ray of the foot, usually in three projections, because in a straight position the phalanges overlap each other and the fracture line may not be visible. The image shows not only the presence of a fracture, but also displacement, involvement of the joint and damage to neighboring bones. For fractures of the base of the thumb and complex intra-articular injuries, computed tomography is prescribed. If the athlete's pain increases gradually and the x-ray is normal, a stress fracture is suspected and an MRI is performed, which shows bone swelling at an early stage.
- X-ray of the foot in direct, lateral and oblique projections
- CT scan for intra-articular fractures
- MRI for suspected stress fracture
- Inspection of the wound for an open injury
- Assessment of blood supply and sensitivity of the finger
Treatment
In the first hours, you need to elevate your leg, apply cold through the fabric for 15–20 minutes several times a day and limit the load. A non-displaced fracture is most often fixed with a plaster to the adjacent healthy toe, placing a gauze strip between them, and shoes with a hard sole and a wide toe are selected. If there is displacement, the doctor performs a reduction under local anesthesia. Surgery with fixation with pins or screws is needed for unstable and intra-articular fractures, especially of the thumb, and for open injuries. Plaster of the entire foot is rarely used.
- Elevated leg position and cold in the first days
- Fixation to an adjacent finger in case of a fracture without displacement
- Shoes with hard soles and wide toes
- Reduction under local anesthesia in case of displacement
- Fixation with a pin or screw for unstable fractures
- Pain relief as prescribed by a doctor
Timing and possible consequences
While normal phalangeal fractures heal in 4–6 weeks, thumb fractures may require more time and stricter weight-bearing restrictions. Swelling and discomfort when wearing tight shoes sometimes persist for several months - this is normal. Incorrectly healed fractures are dangerous: a crooked toe rubs against shoes, calluses appear, and the distribution of load on the foot changes. In people with diabetes and sensory loss, even minor finger injuries require close monitoring due to the risk of non-healing wounds.
- Fusion usually takes 4–6 weeks
- Swelling may last for several months
- Risk of deformation due to malunion
- Pain under the nail requires a doctor's examination
- Particular caution in case of diabetes mellitus
- Return to sports after permission from the traumatologist