Toe and Forefoot Fractures

Fractures of the toes and forefoot are quite common. Fractures can result from a direct blow to the foot—such as accidentally kicking something hard or dropping a heavy object on your toes. They can also result from the overuse and repetitive stress that comes with participating in high-impact sports like running and basketball.

Although fracturing a bone in your toe or forefoot can be quite painful—it rarely requires surgery. In most cases, a fracture will heal with rest and a change in activities.

The forefoot has 5 metatarsal bones and 14 phalanges (toe bones). There are 3 phalanges in each toe—except for the first toe, which usually has only 2.

All the bones in the forefoot are designed to work together when you walk. A fracture, or break, in any of these bones, can be painful and impact how your foot functions.

Toe and forefoot fractures often result from trauma or direct injury to the bone. Fractures can also develop after repetitive activity, rather than a single injury. This is called a "stress fracture."

Fractures may either be "non-displaced," where the bone is cracked but the ends of the bone are together, or "displaced," where the end of the broken bones have partially or completely separated.

Fractures can also be divided into "closed fractures" where the skin is not broken and "open fractures" where the skin is broken and the wound extends down to the bone.

Open fractures are particularly serious because, once the skin is broken, bacteria can enter the wound and cause infection in the bone. Immediate treatment is required to prevent infection.

Symptoms

The most common symptoms of a fracture are pain and swelling. Other symptoms may include:

• Bruising or discolouration that extends to nearby parts of the foot
• Pain with walking and weight-bearing

First Aid

If you think you have a fracture, it is important to see your doctor as soon as possible. A fracture that is not treated can lead to chronic foot pain and arthritis and affect your ability to walk.

While you are waiting to see your doctor, you should do the following:

• Apply ice to help reduce swelling.
• Elevate your foot as much as possible.
• Limit weight-bearing.
• Lightly wrap your foot in a soft compressive dressing.

Doctor Examination

Physical Examination

When you see your doctor, he or she will take a history to find out how your foot was injured and ask about your symptoms. Your doctor will then examine your foot and may compare it to the foot on the opposite side.

During the exam, he or she will look for:

• Swelling
• Tenderness over the fracture site
• Bruising or discolouration—your foot may be red or ecchymotic ("black and blue")
• Deformity
• Skin abrasions or open wounds
• Loss of sensation—an indication of nerve injury

Imaging Studies

Your doctor will also order imaging studies to help diagnose the fracture.

X-rays. X-rays provide images of dense structures, such as bone. An x-ray can usually be done in your doctor's office.

Most fractures can be seen on a routine plain x-ray. A stress fracture, however, may start as a tiny crack in the bone and may not be visible on a first x-ray.

In many cases, a stress fracture cannot be seen until several weeks later when it has actually started to heal and a type of healing bone called "callus" appears around the fracture site.

Magnetic Resonance Imaging (MRI) scans. If your doctor suspects a stress fracture but cannot see it on a plain x-ray, he or she may recommend an MRI scan. This type of study uses a magnetic field and radio waves to create a computerized image of your foot.

More sensitive than an x-ray, an MRI can detect changes in the bone that may indicate a fracture. Unlike an x-ray, there is no radiation with an MRI. The study takes 40 minutes to do, however and has to be scheduled separately from your doctor's visit.

Treatment

Treatment for a toe or forefoot fracture depends upon:

• The location of the injury
• The type of fracture

Fractures of the Toes

Even though toes are very small, injuries to the toes can often be quite painful.

A fracture of the toe may result from a direct injury, such as dropping a heavy object on the front of your foot, or from accidentally kicking or running into a hard object. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the ground—and your toes are twisted or pulled sideways or in an awkward direction.

The proximal phalanx is the toe bone that is closest to the metatarsals. Because it is the longest of the toe bones, it is the most likely to fracture.

A fractured toe may become swollen, tender and discoloured. If the bone is out of place, your toe will appear deformed.

Treatment

Most broken toes can be treated symptomatically. For several days it may be painful to bear weight on your injured toe. As your pain subsides, however, you can begin to bear weight as you are comfortable. During this time, it may be helpful to wear a wider than a normal shoe.

"Buddy taping" your broken toe to an adjacent toe can also sometimes help relieve pain.

If the bone is out of place and your toe appears deformed, it may be necessary for your doctor to manipulate or "reduce" the fracture. This procedure is most often done in the doctor's office. You will be given a local anesthetic to numb your foot, then your doctor will manipulate the fracture back into place and straighten your toe.