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Broken Toes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Broken toes - Symptoms

It is often difficult to tell if your toe is broken or not. Pain is almost inevitable, especially when pressing over the broken area, but sprains and strains can also cause pain. The toe may also be badly bruised or 'stubbed', giving the same symptoms as a broken toe.

If your toe is deformed then it is likely to be broken or dislocated.

Often, the only way to be certain is to get an x-ray of the toe.

 

How are broken toes treated?

Minor cracks or chips in the toe bone are often able to be treated quite easily; strapping or bandaging of the toes allows the break to heal within about three weeks.

If the break has caused the bone fragments to move by a large amount, then toe manipulation may be needed to realign the bone. This is also used if the toe is dislocated and has not re-positioned itself. A plaster cast may then be needed to hold the break in place while it heals.

Some broken toes need operations to give them the best chance of healing. This can be due to the break being unstable (ie after manipulation, the bone ends are being pulled out of place by adjacent muscles).

Breaks of the smaller toes usually respond well to non-operative management. The big toe, however, takes a large part of the weight when walking and so surgery may be needed to give the strongest healing.

 

What operations may be needed for broken toes?

  • K-wires - Kirschner, or 'K' wires are thin metal rods that are passed across the break area. These hold the break in place until it is healed, usually three weeks later. The wires are usually left with a short length exposed at the skin, and are usually removed with very little discomfort by simply pulling them out with special pliers. The wires need to be kept clean while they are in place, as bacteria could otherwise track to the fracture site to cause a bone infection - this is very hard to then treat and could lead to serious consequences

  • Interosseous wires - these are thin wires, much like fuse wires. They are used to tie the broken toe bones together. Often, these can be left in place permanently

  • Plate fixation - small metal plates are used to span the break site, being held in place with small screws. The plates are left in place permanently, often un-noticed. These are usually used for foot breaks rather than the toes themselves

  • External fixation - complex toe breaks may need this form of fixation to hold fragments in place while they heal. Usually, a thick pin is placed through the skin into the bone either side of the break. A metal bar then spans between the pins, keeping them and therefore the bones still. This is kept in place until the fracture is healed, usually three to four weeks.

 

Often after surgery, a plaster cast will be used to keep the break area protected. This may be made from plaster of Paris or lightweight plastic. You will often need to keep weight off the break area while it heals, and may need crutches for a few weeks. Depending on your break type, special boots may be provided allowing you to walk with or without crutches.

 

 

What can go wrong with broken toes?

  • Delayed union - this is where the toe break takes longer to heal than expected. Whilst this can be an inconvenience, it still results in a fixed bone

  • Mal-union - the break heals in a poor position. If this causes problems with foot function, then further procedures on the toe may be needed

  • Non-union - the break does not heal, even after many weeks. Further procedures may be needed

  • Infection - infected bone is called osteomyelitis, and can be extremely hard to treat. A lengthy course of antibiotics or further surgery can clear the infection, although occasionally the infection does not clear and can even, in a worst case scenario, lead to amputation of the affected toe

  • Stiffness - this is a common result of having a broken toe. Due to a combination of splinting and the break itself, the affected toe may never gain the same movement as before the injury. Physiotherapy exercises may help to reduce this risk

  • Pain - well-healed breaks often cause little problem, although it is quite common to get 'niggling' aches and pains in the fracture area, especially during cold weather or when walking long distances. Occasionally, severe pain may require further procedures for improvement

 

Other relevant SurgeryWise articles: Stubbed toes

 

Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

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