broken big toe

by Todd
(Erwin, TN)

Approximately 17 years ago I had a table fall out of a truck and broke the tip off of my toe bone. At that time, the doctor told me it would likely cause more problems to remove it compared to leaving it as is. At that time I was given a special shoe to wear and told that nothing else could be done but if I had problems the broken tip might need removed. I recently hit that toe extremely hard on my bed frame and have been having severe pain at the end of my toe. The pain has been severe enough that just putting on a sock is not possible and any amount of pain surpasses extreme when touched. Even the pressure of blowing air on it is not tolerated. I just didnt know if removing the broken bone in that toe is something that definitely needs to be considered. Could you please give me your opinion and thoughts as to what course of action I need to take? Thank you.

RESPONSE

Hi Todd,

Without the luxury of examining you and seeing x-rays I really cannot give you specific advice as to what to do with your toe, but I can give you a few thoughts.

The first thought would be that you re-broke the bone at the end of your toe and that is certainly a real possibility. The problem with the bone at the end of the toes is that it may be shattered and the chances of it healing on its own, or even with a surgical shoe or other form of immobilization, may be remote.

Most bone fractures are "cracks" or "breaks" in the bone and if the gap between both ends is not too great, the fracture usually will heal.

I am only guessing here, but because of the location of the trauma, I suspect the bone probably shattered. This is compounded by the fact that years ago you sustained a similar trauma to the toe and I do not know what kind of residual damage you ended up doing with the end of the toe.

I would be curious as to your current age, because that too may play a role in determining a prognosis here.

There are other considerations to take into account here. Not only may the end of the toe bone be broken but the trauma you sustained may have also adversely affected the blood supply at the end of the toe.

At the end of all your toes and fingers, there is a network of vessels. The arterioles bring blood into the end of the toe and then they combine with venules which then collect the blood and bring it back up to the heart.

Two traumas over the years may adversely affect the way this vascular system works and your pain could very well be coming from a vascular stand point. This is the problem I have since I cannot actually examine you.

Another possibility would be nerve damage to the toe at its end. This may partially explain why the toe is so sensitive to air blowing on it.

I think this goes without saying, but if the amount of pain you are experiencing lasts for more than a couple of days, or if the toe is turning various colors such as blue, red or even becomes pale, then the toe needs to be looked at by a doctor in your area.

If an x-ray of your toe does reveal that the end of the bone is shattered, then perhaps having the end of the toe removed might be your best alternative for the simple reason there is no other way to fix a shattered toe, particularly at the end of the toe.

Unfortunately, that is all the "guessing" I can do from here. Have a foot specialist look at your foot and give you a more definitive diagnosis.


Marc Mitnick DPM
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