Toe Fracture

with Rehab

A fracture is a break in the bone that can be either partial or complete. Fractures of the toe bones may or may not include the joints that separate the bones.

SYMPTOMS

  • Severe pain over the fracture site at the time of injury that may persist for an extend period of time.

  • Pain, tenderness, inflammation, and/or bruising (contusion) over the fracture site.

  • Visible deformity, if the bone fragments are not properly aligned (displaced fracture).

  • Signs of vascular damage: numbness or coldness (uncommon).

CAUSES

Toe fractures occur when a force is placed on the bone that is greater than it can withstand.

  • Direct hit (trauma) to the toe.

  • Indirect trauma to the toe, such as forcefully pivoting on a planted foot.

RISK INCREASES WITH:

  • Performing activities barefoot (i.e. ballet, gymnastics).

  • Wearing shoes with little support or protection.

  • Sports with cleats (i.e. football, rugby, lacrosse, soccer).

  • Bone disease (i.e. osteoporosis, bone tumors).

PREVENTION

  • Wear properly fitted and protective shoes.

  • Protect previously injured toes with tape or padding.

PROGNOSIS

If treated properly, toe fractures usually heal within 4 to 6 weeks.

RELATED COMPLICATIONS

  • Failure of the fracture to heal (nonunion).

  • Healing of the fracture in a poor position (malunion).

  • Recurring symptoms.

  • Recurring symptoms that result in a chronic problem.

  • Excessive bleeding, causing pressure on nerves and blood vessels (rare).

  • Arthritis of the affected joints.

  • Stopping of bone growth in children.

  • Infection in fractures where the skin is broken over the fracture (open fracture).

  • Shortening of injured bones.

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation. The toe should be restrained for a period of time to allow for healing, usually about 4 weeks. Your caregiver may advise wearing a hard-soled shoe to minimize stress on the healing bone. Surgery is uncommon for this injury, but may be necessary if the fracture is severely displaced or if the bone pushes through the skin. Surgery typically involves the use of screws, pins, and/or plates to hold the fracture in place. After surgery, restraint of the foot is necessary.

MEDICATION

  • If pain medicine is necessary, nonsteroidal anti-inflammatory medications (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Treatment does not seem to help, or the condition gets worse.

  • Any medicines produce negative side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the affected foot.

  • Discoloration beneath the toenails (blue or gray) of the affected foot.

  • Signs of infection (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Toe Fracture (Phalangeal)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Alphabet

Imagine your right / left big toe is a pen.

Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Toe Extension, Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Grasp your toes and gently pull them back toward the top of your foot. You should feel a stretch on the bottom of your toes and foot.

  • Hold this stretch for __________ seconds.

  • Now, gently pull your toes toward the bottom of your foot. You should feel a stretch on the top of your toes and foot.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch__________ times per day.

STRENGTHENING EXERCISES - Toe Fracture (Phalangeal)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.