Early treatment key to foot injuries

We've all stubbed a toe, stepped down on our foot awkwardly or hurt our feet in an accident. Sometimes there's no damage. But other times, there's pain, swelling and bruising. Dr. Gary A. Pichney, from the Mercy Medical Center Institute for Foot & Ankle Reconstruction, answers questions about proper steps to take after an injury to the toe or foot, when to see the doctor and how long the healing may take.

Question: How can you tell if you've broken a toe or a foot?

Answer: The symptoms associated with a broken bone in the foot usually follow some form of a traumatic event. Pain is the first sign that something is wrong. Discomfort when wearing shoes and difficulty walking on the affected foot may indicate that you have broken a toe or foot bone. Any movement of the affected toe or portion of that foot may elicit your painful symptoms. Bruising and swelling may soon follow within two to three hours after the injury. You may also develop blood underneath a toenail. The toe or foot area may also look misshapen as bone fracture can also involve dislocation and joint mal-alignments. Not all fractures are caused by trauma, and some may be related to osteoporosis or other bone abnormalities. Stress fractures of the foot often have no direct acute event which one can associate the injury to.

Q: What immediate steps should be taken?

A: The gold standard for any injury which may involve fracture of the underlying bone is the acronym R.I.C.E. This stands for rest, ice, compression, and elevation. The traumatized area should also be properly positioned while implementing the R.I.C.E. treatment. Most importantly is an evaluation of the injured area in terms of the neurovascular status of the toe or foot. If the blood flow is compromised, seen by a white blanching, or the area becomes numb, this would require immediate medical attention.

Q: When do you need to see a doctor?

A: When a fracture is suspected a visit to the doctor is important. A thorough history and physical exam will be done along with x-rays to confirm the suspected bone injury. This becomes important when dealing with kids who still have open growth plates, and as well with injuries which may violate the adjacent joints. These types of fractures could lead to growth deformations and or post traumatic arthritis without proper medical attention.

Q. How are breaks treated?

A: Basically fractures are treated initially with rest, ice, compression and elevation. Then following determination of the injury type, may require realignment of fracture fragments with closed reduction techniques or sometimes surgically, with open reduction and the application of fixation (pins, plates, or screws) to maintain the repair. Simple fractures of the toes can usually be reduced manually, then buddy splinted to the appropriate neighboring toe and placed in a rigid surgical shoe. More significant fractures of the foot involve more complex treatment options and may involve non-weight-bearing restrictions. Fractures generally require four to eight weeks to heal completely. But return to full activities without restriction may extend past this period of time.

Q: What can be done about the pain?

A: Stability of the fractured bone portions is key to pain reduction. Whether through open or closed techniques the injured area will be splinted, taped, casted, or fixated so that motion is reduced between the fractured portions of bone. That stability is what reduces your painful symptoms. The more activity one does during the recovery period, the more stresses are placed onto the fracture site, and the more pain one would expect to have. A short course of pain medication may also be indicated early on in treatment.

Q: What are the immediate and long-term complications?

A: Unfortunately, even with appropriate treatment, post traumatic sequelae may occur after fractures to the foot or the toes. Problems can include delayed healing, non-healing, mal-aligned healing, prolonged pain and swelling. All of these are dependent upon many individual patient factors making early diagnosis and appropriate implementation of treatment important to assure the best chances for a good outcome.

So, if you think you may have broken your toe or your foot, get it checked out ASAP.



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