Broken Toes
St.
Peter’s Catholic Church is a tiny house of worship located at the 5 mile
turn around where the Ironman Hawaii competitors head back to town and
their journey on the Queen Ka’ahumanu Highway. If memory serves, there
have been five different run courses since the race moved to the Big
Island from Oahu in1981.
True story. A local athlete participates in the regional 70.3 race, and
seemingly coordinated in other aspects of life (yes, he can walk and chew gum at
the same time) he has broken a toe twice at this race site before really getting
his race going.
The first was his big toe having finished his warm up
swim, wading back to the starting line, when he kicked a submerged rock…and
Whammo – broken toe. Two years later, after exiting the 1.2 mile swim, running
to the transition area on a long green miniature golf-like carpet, he tripped on
a small fold in the carpet…and Whammo #2, a 4th toe broken on the other foot
and the nail pulled 1/2 way off. And bleeding!. He finished both
races!
Most broken toes are the result of trauma although I’d expect
several of you to have suffered stress fractures of the same bones. We’re
covering the former today. Usually they occur secondary to an axial load such as
a stubbed toe or some type of crush injury…such as dropping your bowling ball
on it. Most will have significant pain at the time of injury although those with
preexisting osteoporosis (thinning of the bones or loss of bone stock) may have
less. Accompanied by less trauma. The injured usually are noted to have point
tenderness at the site of the fracture although the skin is normally intact. The
toe may be pointing a different direction…always a bad sign!
Although
it’s usually not an emergency, an early x-ray can be very helpful both in
diagnosing the type and location of fracture, displacement if any, etc. A
negative x-ray is no less useful. Also, in children, an x-ray can frequently
reveal the presence or absence of a growth plate injury.
In fractures of toes 2-5, usually both the injury and treatment are less involved. Oftentimes, if the fracture is satisfactorily aligned and stable, simply taping the toe to it’s next door neighbor, avoiding activities which might tend to displace the ends of the bones and occasionally a fracture shoe are all that’s needed. However, a break in the bog toe is a horse of a different color given the importance of this structure in balance, directional control and weight bearing. If displaced or into the joint, the fracture needs to be reduced and the joint needs to be maintained. This can occasionally require a surgical procedure and prolonged post operative immobilization.
In short, if you think you may
have broken a toe, and the pain doesn’t subside in a reasonable time, why not
let you local Urgent Care or health care provider take a gander and consider an
x-ray.