Broken Foot or Broken Toes
Nearly one-fourth of all the bones in your body are in your feet, which provide you with both support and movement. A broken (fractured) bone in your forefoot (metatarsals) or in one of your toes (phalanges) often is painful but rarely disabling. Most of the time, these injuries heal without surgery. Since a dislocation can be mistaken for a toe fracture, it is important to obtain X-rays to ensure a correct diagnosis.
Symptoms
Pain, swelling, and bruising are the most common signs of a fracture in the foot. If you have a broken toe, you may be able to walk but this usually aggravates the pain. If the pain, swelling, and discoloration continue for more than 2-3 days, or if pain interferes with walking, something could be seriously wrong; see your foot and ankle orthopedic surgeon as soon as possible. If you delay getting treatment, you could develop persistent foot pain and arthritis. Pain also can change the way you walk (your gait), which could lead to painful calluses on the bottom of your foot or other issues.
Causes
Stress fractures frequently occur in the bones that extend from your toes to the middle of your foot (metatarsals). Stress fractures are like tiny cracks in the bone surface. They can occur with sudden increases in physical activity, such as running or walking for longer distances or times, improper training techniques, or changes in training surfaces. They may be related to the shape of the foot, an overly tight calf muscle or heel cord (Achilles), or metabolic or nutritional factors.
Traumatic fractures result from a sudden force, such as a fall, dropping a heavy object on your foot, or a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. These fractures may be stable with no shift in bone alignment or displaced with bone ends that no longer line up.
Several types of fractures can occur to the forefoot bone on the side of the little toe (fifth metatarsal). Ballet dancers may break this bone during a misstep or fall from a pointe position. An ankle-twisting injury may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is a Jones fracture, which occurs near the base of the bone and disrupts the blood supply to the bone. This injury may take longer to heal or require surgery.
Diagnosis
Your foot and ankle orthopedic surgeon will examine your foot to pinpoint the central area of tenderness and compare the injured foot to the normal foot. You should tell your surgeon when the pain started, what you were doing at the time, and if there was any injury to the foot. X-rays will show most fractures of the forefoot and should be obtained standing if possible to improve diagnostic accuracy. A CT scan or MRI may be needed if the fracture enters a joint, or if X-rays fail to reveal an injury.
Treatment
See your foot and ankle orthopedic surgeon as soon as possible if you think that you have a broken bone in your foot or toe. Until your appointment, keep weight off the painful area and apply ice to reduce swelling. Use an ice pack or wrap the ice in a towel so it does not come into direct contact with the skin. Apply the ice for no more than 20 minutes at a time. Take acetaminophen or ibuprofen to help relieve the pain. Wear a wider shoe with a stiff sole to remove stress from the injury site.
Rest is the primary treatment for stress fractures in the foot. Stay away from the activity that triggered the injury, or any activity that causes pain at the fracture site, for 3-4 weeks. Substitute another activity that puts less pressure on the foot, such as swimming. Gradually, you will be able to return to activity. Your surgeon, physical therapist, or coach may be able to help you pinpoint the training errors that caused the initial problem so you can avoid a recurrence.
If you have a displaced fracture, the bone ends must be realigned and the bone kept immobile until healed. If you have a broken toe, the doctor will “buddy tape” the broken toe to an adjacent toe, with a gauze pad between the toes to absorb moisture. You should replace the gauze and tape as often as needed. Remove or replace the tape if swelling increases and the toes feel numb or look pale. If you have diabetes with neuropathy or peripheral neuropathy (loss of sensation in the toes), do not tape the toes together. You may need to wear a rigid, flat-bottom orthopedic shoe for several weeks.
If you have a broken bone in your forefoot, you may have to wear a short-leg walking cast, a brace or a rigid, flat-bottom shoe. It could take 6-8 weeks for the bone to heal, depending on the location and extent of the injury. After a week or so, your foot and ankle orthopedic surgeon may request another set of X-rays to ensure that the bones remain properly aligned. Many of these fractures are treated successfully without surgery, although in severe injuries, pins or screws may be required to hold the bones in place while they heal. Surgery often is not needed to treat fractures in the toes or forefoot. However, when it is necessary, it has a high degree of success.
Recovery
The forefoot and toes tend to heal slowly, so it can take months for a fracture to heal. In the toes, swelling can continue for a long time even when patients are not having other symptoms.
Risks and Complications
Risks associated with these fractures are specific to the injury. If the fracture goes into a joint, it could lead to arthritis. If the skin is broken at the time of the injury, you could develop an infection.
On occasion, the bone does not heal. In other cases, pain or swelling can remain. For these reasons, it is important to have further follow up with your surgeon if you continue to have symptoms.
