Fractures of the toes and metatarsal bones can be painful and significant injuries. The foot is a complex structure comprised of bones, muscles, tendons, and other soft tissues, with a total of 28 bones, including 19 toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). These fractures, whether in the toes or metatarsals, are common and should be evaluated by a specialist. Even if initial treatment has been received in an emergency room, it’s essential to seek proper diagnosis and treatment from a foot and ankle surgeon.

Understanding Toe and Metatarsal Fractures

A fracture is a break in the bone, and it can be categorized as a traumatic fracture or stress fracture.

Traumatic fractures, also known as acute fractures, occur due to a direct blow or impact, such as a severe stubbing of the toe. These fractures can be either displaced (where the bone shifts position) or nondisplaced.

Signs and symptoms of traumatic fractures may include:

• An audible sound at the time of the break.
• Intense pinpoint pain at the site of impact at the time of the fracture, which may persist for a few hours before subsiding.
• An abnormal appearance or crookedness of the affected toe.
• Bruising and swelling the following day.

It’s important to note that the belief “if you can walk on it, it’s not broken” is not accurate. Evaluation by a foot and ankle surgeon is always recommended.

On the other hand, stress fractures are tiny hairline breaks typically caused by repetitive stress. They often affect athletes who rapidly increase their running mileage or individuals with abnormal foot structure, deformities, or osteoporosis. Inappropriate footwear can also contribute to stress fractures. Seeking proper medical attention is crucial for the correct healing of stress fractures.

Symptoms of stress fractures may include:

• Pain during or after normal activities.
• Pain that diminishes during rest but returns when standing or engaging in activity.
• Pinpoint pain when the fracture site is touched.
• Swelling without bruising.

Consequences of Improper Broken Toe Treatment

Some people erroneously believe that nothing can be done for a broken bone in the foot. However, this is generally not true. If a fractured toe or metatarsal bone is not treated correctly, it can lead to serious complications, such as:

• Deformity in the bone structure, potentially limiting foot movement and causing difficulties with footwear.
• Arthritis can result from a fracture in joint or angular deformities that develop when a displaced fracture is not properly corrected.
• Chronic pain and deformity.
• Nonunion, where the bone fails to heal, leading to the need for subsequent surgery or chronic pain.

Treatment of Toe Fractures

Fractures of the toe bones are typically traumatic. Treatment options for traumatic toe fractures depend on the specific injury and may include the following:

• Rest: In some cases, rest alone may be sufficient for healing a traumatic toe fracture.
• Splinting: A splint may be used to immobilize the toe and maintain its position.
• Rigid or stiff-soled shoe: Wearing a shoe with a stiff sole can protect the toe and ensure proper alignment. Postoperative shoes or boot walkers can also be beneficial.
• Buddy taping: Taping the fractured toe to an adjacent toe may be appropriate in some cases but can be harmful in others.
• Surgery: Surgery may be necessary for severely displaced fractures or when the joint is affected, often involving the use of fixation devices like pins.

Treatment of Metatarsal Fractures

Fractures in the metatarsal bones can be either stressful or traumatic. Specific types of metatarsal fractures present unique challenges, such as those involving the first metatarsal bone (behind the big toe) or Jones fractures at the base of the fifth metatarsal bone (behind the little toe).

Treatment options for metatarsal fractures depend on the type and extent of the fracture and may include:

• Rest: Rest alone may be sufficient for healing stress or traumatic metatarsal fractures.
• Avoiding the triggering activity: As stress fractures result from repetitive stress, it’s crucial to avoid the activity causing the fracture. Crutches or a wheelchair may be necessary to offload weight from the foot for proper healing.
• Immobilization, casting, or rigid shoe: A stiff-soled shoe or other immobilization methods can protect the fractured bone during the healing process. Postoperative shoes or boot walkers may also be helpful.
• Surgery: Some traumatic metatarsal fractures may require surgery, particularly if the fracture is significantly displaced.
• Aftercare: Your foot and ankle surgeon will provide instructions for post-treatment care, which may include physical therapy, exercises, and rehabilitation as part of a plan for a return to normal activities.