Toe fractures are common injuries. The toes are particularly susceptible to fracturing as they are positioned on the end of a moving foot, where any stubbing force or heavy dropped weight can cause injury to their small bones. The toes have differing numbers of bones. The big toe has two bones, while the smaller toes each have three bones. The bones are collectively known as phalanges, and are vaguely dumbbell-shaped, although the end bone is more squashed into an arrowhead-like shape. Injuries generally occur to these bones due to a crushing force from above the toe, or a smashing force from the tip of the toe. Many of these injuries simply result in a bruising or strain of the toe tissue. At times, however, the injury is strong enough to break the bone.
Fractures of the toe bones can take numerous shapes. The fracture can run straight across, at an angle, or can even break into several pieces if the force is strong enough to crush the bone. The toe fracture may even only partially go across the width of the bone, resulting in a green-stick fracture. Small chips may be present if only the end of the bone is involved, and if the fracture crosses the end of the bone into the joint space with the next bone, the motion of that joint will be adversely effected. Externally, the toe will usually become swollen, red, and/or bruised. It will be painful to the touch, or with shoe pressure. At times, however, these symptoms may be minimal and the toe may not 'feel' fractured.
Toe fractures generally stay in place, with the bone fragment moving only slightly out of alignment. For this reason, many toe fractures easily heal on their own, helped along by splinting (with tape) to the more stable toe next to it. Bones generally take six weeks to heal, and toe bones are no exception. As the bone is held into place by securing the toe into the the non-fractured toe next to it, it can slowly fuse itself back into a solid bone. If there is extra motion of the toe that lets the bone fragments shift and move, the healing can take longer, or the bone will heal in an abnormal position. The abnormal bone position can lead to new pressure points on the top or sides of the toe, which can lead to painful corns. Abnormally healed fractures that involve a joint can also lead to future early arthritis. These complications are why it is important to properly splint a broken toe bone. After five or six weeks, the toe should be fully healed, although any pain or swelling from the fracture may have already resolved before that point.
Some fractures, especially those of the big toe, can be more unstable and require more treatment than simply splinting the toe. These fractures have pieces that have split apart too far for the bone to heal naturally without help, or at least too far apart to heal in a proper position. These fractures may need to be manipulated back into place with traction from a physician's fingers. This generally requires the toe to be numbed with an anesthetic, as it can be quite uncomfortable. The repaired fracture is then splinted until it is healed. If the fracture cannot be returned into a proper position with this maneuver, or if the fracture is severely unstable, surgery may be necessary to put the bone into a proper position. The position is then usually held with some form of hardware, like a wire or pin, that will keep the unstable bone in place until it is healed.
Regardless of severity, toe fractures should be evaluated by a physician to ensure that the needed treatment leads to a healthy toe that lacks deformity or joint disease.