Stubbed Toe – Lesser Toe Injury
Summary
Most people have smashed one or more of their toes against against a solid object — often in the middle of the night. A “stubbed toe“ can be excruciatingly painful! Sometimes the symptoms associated with this type of toe injury resolve fairly quickly. Other times there’s considerable damage with a longer recovery, or occasionally the need for surgery. The reality is that the severity of a stubbed toe falls on a spectrum from mild to severe — essentially from a mild bruise to a severe fracture-dislocation of one of the joints of the toe. The spectrum of stubbed toe injuries includes:
A Stubbed Toe with Bruising Only
A majority of stubbed toes lead to bruising only. A bruise or contusion of the toe is painful, leads to swelling and discoloration, but does not require any treatment other than symptomatic management. Differentiating a bruise from a more serious injury can sometimes be challenging. There are certainly displaced toe fractures that were initially diagnosed as a contusion. However, in general if the toe is still aligned and the joints move smoothly a significant toe injury is unlikely. Treatment is rest, ice, and if needed limiting activity until symptoms have improved. The use of a stiff shoe with a wide toe box can also be beneficial.
A Stubbed Toe Causing a Toe Fracture
Sometimes a stubbed toe will cause a fracture to one or more of the phalangeal bones of the toe. These toe fractures are very painful! The necessary treatment is dictated by the severity of the toe fracture. If the fracture is undisplaced or only minimally displaced with no apparent angulation of the toe it can be treated conservatively. Treatment typically involves icing, activity limitation, and a stiff sold shoe with a wide toe box. These undisplaced toe fractures will heal well, although recovery can be considerably slower than a bruised toe with symptoms lasting a number of weeks. Residual stiffness of one or more of the joints of the toe is common after a fracture.
However, if a badly stubbed toe causes a toe fracture that is notably displaced to the point where the toe is clearly deformed then more specific treatment by a physician may be necessary. This occurs when the fracture is considerably angulated or the fracture is associated with a dislocated or displaced joint injury. Directly visualizing the toe will reveal a notable deformity with the toe in an unacceptable position. If the position of the injured toe is not acceptable a formal repositioning of the toe fracture will be necessary. Manipulating the toe to improve the position of the toe fracture can often be done under local anesthetic, although at times formal surgery is required. In addition, if a stubbed toe is associated with an open wound it may need formal medical attention.
A Stubbed Toe Causing a Joint Injury
In addition to bruising and a possible fracture, a stubbed toe may cause an injury to one of the three joints of the toe. These toe joint injuries can range from:
- partial tearing of the ligaments of the joint capsule
- an avulsion fracture where the ligament pulls off a fragment of bone associated with the joint
- an articular fracture that disrupts the articular surface of the joint
- an acute disruption of the plant plate which is the strong ligament that stabilizes the floor of the joint at the base of the toe (the metatarsophalangeal joint or MTP joint)
- a subluxation or dislocation of the joint where enough of the restraining joint ligaments have been torn that the joint is now out of position
The treatment of a joint injury from a stubbed toe is dictated by the severity of the injury. If the joint remains acceptably positioned, even if there’s considerable ligament damage or a fracture conservative treatment can be effective. However, if the injured toe joint is malpositioned due to a fracture, subluxation, or dislocation, a formal repositioning of the joint and the associated bones is often necessary. If the joint is acceptably positioned or has been repositioned in a satisfactory manner treatment typically involves limiting activities, elevating the foot, protecting the toe with a stiff soled shoe and a wide toolbox, and allowing time to let all the injured structures heal. Once adequate bone and soft-tissue healing has occurred gentle range of motion exercises can be started. This is done to limit the toe stiffness that often occurs following this type of toe injury. Fortunately, most stubbed toes do not reach this level of severity.
June 17th, 2024