Great Toe Crush Injury

Summary

Dropping an object on the toes is a painful, all too common injury. Crush injuries affecting the great toe range in severity from mild annoying discomfort, to a devastating crush injury that can lead to the loss of the great toe. The severity of the injury will be dictated by the extent of soft tissue damage. Loss of blood supply to the great toe may be particularly devastating. For a mild great toe crush injury, symptomatic management with elevation, ice, and anti-inflammatory medications combined with a stiff soled shoe to protect the toe may be all that is needed. More severe injuries will usually need to be managed by a physician.

Overview of a Great Toe Crush Injury

Dropping an object on the toes, particularly the great toe, is a frequent injury. A crush injury to the great toe ranges in severity from a painful owie that will resolve quickly, to a devastating crush injury that can lead to the loss of the great toe. The severity of the injury will be dictated by the extent of soft tissue damage. Soft tissue damage is determined by the weight of the object and how far it has fallen, as well as the baseline health of the tissue. Individuals with underlying diabetes or vascular disease are at much higher risk for a devastating soft tissue injury following, a crush injury to the great toe. Similar to a stubbed great toe a crush injury can lead to bruising, fracturing, and/or a joint injury. However, by the nature of the injury mechanism a crush injury is more likely to lead to a compromise to the blood supply of the toe. The viability of the great toe will be in jeopardy if the blood supply to the toe is markedly compromised. This is why work-related and other crush injuries involving very heavy loads can be so devastating – and why steel-toed safety boots can be so effective in preventing or limiting the effect of a great toe crush injury. Fortunately, most great toe crush injuries will not compromise the blood supply, and will heal over time.

Symptoms of a Great Toe Crush Injury 

When an object is dropped on the great toe, immediate pain will be felt. The toe will often swell quickly. There may be noticeable bruising or even bleeding. If the crush injury affects the toenail blood may form under the toenail, creating a painful subungal hematoma. Walking may be difficult. Elevating the foot may help improve the symptoms somewhat

The extent of the great toe injury will be determined by examining the toe. Obtaining an x-ray may be necessary if there is noticeable swelling, an obvious deformity, or findings that suggest a more severe injury. Bruising, an open wound, blood under the toenail (subungal hematoma), or noticeable deformity can be identified just by looking at the toe. Identifying a fracture or significant disruption of one of the great toe joints may require an x-ray. Perfusion of the toe can be assessed by looking for capillary refill -whether blood returns to the tip of the toe. By pressing on the soft tissue at the end of the toe blanching of the skin should be noted. The color of the toe should return quickly once the finger has been removed. If it does not, this suggests some compromise to the blood supply of the great toe.

Treatment of a Crushed Great Toe 

Most great toe crush injuries can be treated conservatively. Elevation, icing, and possibly anti-inflammatory medication can help with initial pain control. If the toe is still straight and the joints can move management can be with a stiff sold shoe in a wide toolbox, limitation of activities until the swelling and pain settles often days or a week or two. 

For more severe injuries, a formal assessment, including x-rays may be needed. If the toe is well positioned and there is no fracture that needs to be treated. These injuries can also be managed conservatively. This is commonly done by protecting the toe in a stiff shoe boot and limiting activities until healing occurs. This can be a number of weeks, particularly if there is an involved fracture. Following healing, exercises or therapy to get the toe moving may be beneficial. 

For severe great toe crush injuries where there is an open wound, or significant displacement of a fracture surgery may be needed. Once surgery has addressed the soft tissue damage and/or fracture position a similar recovery routine is instituted with immobilization over 4-6 weeks to allow for bony and soft tissue healing, followed by range of motion exercises.

June 17th, 2024