Toe & Forefoot Fractures

Causes of Toe and Forefoot Fractures

Traumatic fractures occur when there is a direct impact of your foot on a hard surface.

Stress fractures are tiny hairline or small cracks in the bone, most commonly caused due to overuse or repeated stress. It commonly develops in the weight-bearing bones of the lower leg and foot.

When the muscles of the foot are overworked, or stressed, they are unable to absorb the pressure resulting from a rapid increase in the intensity. They can also be caused by

• a change in the surface of a sports activity (such as changing from soft clay court to hard court in tennis),
• increased physical activity without adequate rest and
• wearing worn-out or uncomfortable footwear.

Athletes participating in certain sports such as basketball, tennis and gymnastics are at a greater risk of developing stress fractures as they experience repeated stress on the foot each time they land on a hard surface. 

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.

Fifth Metatarsal (Jones) Fractures

The metatarsal bones are the long bones in your feet. There are five metatarsal bones in each foot. The fifth metatarsal is the long bone that is located on the outside of the foot and connects to the small toe.

There are two types of fractures that often occur in the fifth metatarsal,

• Avulsion Fracture - a piece of the bone is pulled off the main portion of the fifth metatarsal by the tendon that attaches to this region.
• Jones fracture - a fracture in a small area of the fifth metatarsal that receives limited blood supply, either be a stress fracture or an acute (sudden) break

Other foot fractures include:

• Mid-shaft fractures,
• Fractures of the metatarsal head and neck may occur in the fifth metatarsal.

Symptoms of Toe and Forefoot Fractures

The most common symptom of a toe and forefoot fractures is

• Pain, which usually worsens with activity and decreases with rest.
• Bruising,
• Swelling,
• Tenderness and
• Inability to walk may also occur.

Diagnosis of Toe and Forefoot Fractures

To detect toe and forefoot fractures, your doctor conducts

• History - to find out how your foot was injured and ask about your symptoms
• Physical Examination  - of the foot with comparisons to the foot on the opposite side.
• X-rays - identify the location and severity of the fracture 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.
• 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.

Non Surgical Treatment of Toe and Forefoot Fractures

Even though toes are very small, injuries to the toes can often be quite painful. The proximal phalanx is the toe bone that is closest to the metatarsals, if the bone is out of place, your toe will appear deformed.

Initial treatment for Toe and forefoot fractures can include:

• R.I.C.E. To reduce the pain and swelling surrounding the injured area.
• Rest: Rest the affected area as more damage could result from putting pressure on the injury.
• Ice: Ice should be applied over a towel to the affected area for 15-20 minutes every two to three hours during the day. Never place ice directly over the skin.
• Compression: Wrapping with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling and provide support to the injured area.
• Elevation: Elevating the injured area above heart level will also help with swelling and pain
• Crutches may be recommended to keep you from putting weight on your leg
• Cast: cast boot, or stiff-soled shoe may be needed to immobilize your foot
• Immobilization: Splints, braces, rigid shoes (stiff-soled shoe) or buddy taping (fractured toe is taped to the adjacent toe) may be suggested to immobilize and allow the bone to heal.

Surgical Treatment of Toe and Forefoot Fractures

If the fracture fails to unite, or heal, or if the injury involves a displaced bone, or multiple fractures, surgery will likely be recommended. 

Surgery:

Your doctor realigns the fractured bones. Surgery may include:

• using pins or screws to stabilize the fractured bone in place until they heal completely , 
• bone graft may be used to stimulate a healing response.

Your doctor will discuss the type of procedure that may be needed for your condition.

What if Toe and Forefoot Fractures goes Untreated?

A fractured toe that's left untreated it can increase the risk of developing a bone infection.

If you have diabetes, rheumatoid arthritis, or a compromised or weakened immune system, other complications can follow.

Prevention of stress fractures

Some of the following measures may help to prevent stress fractures:

• Start any new sport activity slowly and progress gradually.
• Cross-training or altering exercises can prevent overstressing one part of the body. 
• Maintain a healthy diet and include calcium and vitamin D-rich foods in your diet.
• Wear well-fitting and comfortable footwear specifically designed for the sports activity and avoid using old or worn out shoes.