Fractures of the toe bones are very common lower edge fractures faced by many people. These kinds of fractures are normally caused by a serious injury or axial force like bashing a toe. In some occasions, such injury may be caused by joint hyperextension or different stress factors. Most patients feel localized pains at the fracture location or pain with gentle axial loading of the digit. Anteroposterior and oblique radiographs are generally taken for identifying fractures, defining displacement of bones, and evaluating conditions of adjacent phalanges and digits. In some extreme cases, patients with multiple of fractures and severe pain may be admitted to the hospital; otherwise, patients with closed fractures of the toe bones are treated at homes. Children with fractures of the physis (growth plate) are normally referred to the nearest hospitals, but children with particular non-displaced Salter-Harris types I and II fractures are treated by family physicians.
What is Closed Fracture?
A fracture is called closed one when the bone breaks, but no immediate puncture or open wound in the skin is detected, whereas in an open fracture the bone breaks through the skin; it may then retreat back into the wound and not be visible through the skin. In a closed fracture, the bone may either be completely broken or partially broken.
Closed Fracture of Toe Bones (Phalanges)
The first toe has two phalanges whereas the remaining four toes have three phalanges. In some cases, the fifth toe may have two phalanges too. The phalanges are connected to the bones of the foot with tendons and muscles. The tendons can avulse small fragment of bones from the phalanges if sudden stress is applied on the tendons. Three muscles, viz. abductor, interosseous and adductor linked with proximal phalanx may aggravate fracture of the toe bones if these muscles get sudden pull.
Almost two-thirds of all bones in the feet belong to the toes; hence the risk of fracture in this part of the foot is much higher than the rest of the foot. Closed fracture of the toe bones happens when the toe bones or phalanges are exposed to sudden force causing the bone to break either partially or completely; however, the bone does not protrude out of the skin making a wound.
Symptoms of Closed Fracture of Toe Bones (Phalanges)
Most of the symptoms of closed fracture of the toe bones (phalanges) are quite visible from outside, like the following ones -
- Pain in the injured region along with swelling or stiffness.
- Bruising of the skin around the toe bones may also be noticeable.
- In some extreme fractures, the affected toe may look deformed from outside due to the displacement of one or more bones.
- Walking is difficult for the injured person. If the big toe is fractured neither walking, nor wearing shoes will be possible.
Some other issues may also develop immediately after the injury or some days later. The feet may begin to swell along with increasing pain. Nail adjacent to the fractured toe may also get subungual hematoma, which may require drainage by making a small hole.
Causes of Closed Fracture of Toe Bones (Phalanges)
Fracture of the toe bones are mainly caused by different types of injuries, such as stubbing one or more toes or foot, dropping weighty objects on the toes etc. It is also detected that sports persons get broken toes due to over stress on certain toes.
Diagnosis of Closed Fracture of Toe Bones (Phalanges)
Most toe fractures are caused by stubbing or injury from a falling object. Again, spiral or avulsion fractures may be caused by joint hyperextension, which is more common among athletes.
Externally, the injured area looks swelled, bruised and a throbbing pain is felt continuously. If not treated immediately after injury, the pain may further worsen. In many cases, an isolated subungual hematoma may also be detected with increasing pain and swelling. Doctors undertake the following findings also –
- The skin is inspected for open injuries, if any.
- The nail is inspected for subungual hematomas and other related injuries.
- Any deformity in the nail is also detected.
Differential Diagnosis of Closed Fracture of Toe Bones (Phalanges)
Differential diagnosis is very important in closed fracture of toes, because the same mechanism that cause toe fractures may also cause other injuries leading to dislocation of bones, ligament sprain, contusion and tendon injury etc. In this circumstance, radiograph is the only option in the hand of doctors to differentiate the issues. In case of stress fractures in toes, which is typically based on proximal phalanx, radiographic detection process may not work initially.
Is Hospitalization Required for Closed Fracture of Toe Bones (Phalanges)?
In some situations, hospitalizing the persons with closed fracture of toe becomes inevitable. Here are some indications –
- Fracture of First Toe: This toe bears the maximum weight of the body, keeps balance of the body, and helps in pedal motion. Hence, closed fractures can cause deformity, decreased or painful motion, and degenerative joint disease. Referrals are usually made when the functional ability of the toe is impaired severely. Normally, referral to hospitals is suggested for patients with dislocations, displaced intra-articular fractures, and unstable displaced fractures. Referral is also recommended for children with first-toe fractures involving the physis. These injuries may require internal fixation.
- Fractures of the Lesser Toes: Referrals for fractures in other toes are comparatively less, except in those conditions where pain is too severe or movements seem very painful. In conditions such as fracture-dislocations, displaced intra-articular fractures, and for children when fractures involve physis referrals may be suggested.
Treatment of Closed Fractures of Toe Bones (Phalanges)
Different treatment procedure is done for different types of closed fractures of toes –
- Treatment for Non-Displaced or Stable Fracture of Toe Bones (Phalanges): For closed fractures of non-displaced or stable pattern, splint is applied and the patient is given a specially designed shoe for minimum possible joint movement. A walking cast may be used depending on the extent of fracture. Treatment continues till the tenderness is completely resolved. To relieve pain, non-narcotic analgesics are given. After 3-4 weeks, the patients are advised to begin walking short distances and some light exercises to gain back strength.
- Displaced Fracture of Lesser Toe Bones Treatment: In most of the cases, displaced fractures in lesser toes are generally found to be less severe than the displaced fractures in the first toe. Patients are generally treated at home if the pain or swelling is not too severe. After anesthetizing the affected toe, the doctor applies traction to place the fragmented bones of the lesser toes in proper positions. This is then splinted with buddy taping. If in spite of this traction and splinting, the adjusted positions of the fractured bones are not maintained, the doctor may suggest hospitalization.
- Treatment for Displaced Fractures of the First Toe Bone: Experts try to adjust the fractured bones as anatomically correct as possible. In case the bones are not getting their original positions even after several tractions, doctors advise for hospitalization. Surgery might also be required if other methods fail to bring the bones back in place.
Complications of Closed Fracture of Toe Bones (Phalanges)
Timely treatment is necessary in closed fractures. If that is not undertaken, pain may intensify and normal activities may hamper. If pain still persists after traction and splinting, it may be an indication of maladjustment of fractured bones. Some intra-articular fracture may also lead to joint diseases later.
Closed fracture of the toe bones or phalanges needs the quickest possible attention and action. Athletes, under vigorous training, may face this sort of issue at any time. Common people may also get injuries leading to closed fractures of one or more toes. Ice packs, pain relieving sprays and pain killers can provide some immediate respite; but fractured bones need to be anatomically adjusted with the help of tractions. Such tractions should be taken from an expert physician or orthopedic surgeons. Most of the closed fractures of the toes are rectified within 3-4 weeks' time; however, severe fractures may need some more time to recover.