What is it with broken toes?

So, interweb health care advice is tricky. Lots of unknowns. And there are different practice patterns in different parts of the US. And if you are in Canada, things get even more variable, eh? And how do you know that anybody's advice is sound?

But if you are a healthy, active, non smoker, most (all?) of the foot and ankle docs I have worked with in Denver would advise surgery for your injury. Their advice would focus on 3 topics. You mentioned concerns for blood supply. I think this is a rare complication of this fracture that may be decreased with surgery. But it is a rare complication that would likely cause significant arthritis that could be treated with a fusion of that joint in the future if needed.

The biggest concern about this fracture is that it is intra articular/ broken joint surface. I was a bicycle mechanic in a previous life and I describe the joint surfaces like the cups and cones of the old wheel hub. If things aren't smooth, it will wear out early. AKA arthritis. The intention of the surgery is to align the joint surfaces as best as able. Even a 1-2 mm irregularity in the joint surface increases the risks for arthritis. Perhaps earlier and more severe as well. But keep in mind that the injury has already predisposed the joint to arthritis, so surgery is no guarantee of a pain free toe. There is no sure bet, but if it becomes chronically painful, the involved joint could be fused in the future.

Another intention of surgery is to avoid deformity. When we get even older than we already are, plenty of us loose protective sensation in our feet and a deformed toe can cause wounds on the feet that cause infections and potential amputations.

So my advice is to seek another opinion, maybe a few, and keep going until you have met a doc that you feel comfortable with and trust. If surgery is elected, any time within the first 2 weeks or so after the injury should not complicate the surgical repair.

Lastly, that MacGievered thing on your foot is gonna tear your skin off. I prefer Coban or vet tape to that sticky stuff as it sticks to itself, not your skin. Maybe tape the big toe to the long toe and use the post op shoe and loose the outrigger? But you do you.

I hope that this is more helpful than confusing and best of luck with a rapid recovery.

^^the last paragraph is good advice. If you can find 1” coban or even 1/2” I’d buddy wrap the 1st and 2nd toes. Maybe put a bolster like a dental roll between the toes for alignment and WEAR the post op shoe.


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Lots of medical advice here from non-medical professionals, but I guess that’s the TGR way!

Yes, the blood supply to the bone is within the bone and can be disrupted with certain fractures. Loss of vascularity (leading to non-union, or AVN)can be a risk with certain fractures ie Jones fracture of the fifth metatarsal or scaphoid.
I don’t think that is a big risk for this fracture. The bigger concern is the degree of instability. Will the fracture stay put long enough to heal? If it keeps displacing the way you described it initially is a bit concerning. I’m definitely impressed with your Franken-splint!


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Originally Posted by MakersTeleMark

I broke the same foot 2x this year on opposite sides. FML. I'm getting really good at reeling back and healing quickly, but it is really tough.

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Hope you are better quickly, and I'll try not to do that.

Hey folks - protect your toes. I may reconsider going shoeless at home.

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Originally Posted by timackie

So, interweb health care advice is tricky. Lots of unknowns. And there are different practice patterns in different parts of the US. And if you are in Canada, things get even more variable, eh? And how do you know that anybody's advice is sound?

But if you are a healthy, active, non smoker, most (all?) of the foot and ankle docs I have worked with in Denver would advise surgery for your injury. Their advice would focus on 3 topics. You mentioned concerns for blood supply. I think this is a rare complication of this fracture that may be decreased with surgery. But it is a rare complication that would likely cause significant arthritis that could be treated with a fusion of that joint in the future if needed.

The biggest concern about this fracture is that it is intra articular/ broken joint surface. I was a bicycle mechanic in a previous life and I describe the joint surfaces like the cups and cones of the old wheel hub. If things aren't smooth, it will wear out early. AKA arthritis. The intention of the surgery is to align the joint surfaces as best as able. Even a 1-2 mm irregularity in the joint surface increases the risks for arthritis. Perhaps earlier and more severe as well. But keep in mind that the injury has already predisposed the joint to arthritis, so surgery is no guarantee of a pain free toe. There is no sure bet, but if it becomes chronically painful, the involved joint could be fused in the future.

Another intention of surgery is to avoid deformity. When we get even older than we already are, plenty of us loose protective sensation in our feet and a deformed toe can cause wounds on the feet that cause infections and potential amputations.

So my advice is to seek another opinion, maybe a few, and keep going until you have met a doc that you feel comfortable with and trust. If surgery is elected, any time within the first 2 weeks or so after the injury should not complicate the surgical repair.

Lastly, that MacGievered thing on your foot is gonna tear your skin off. I prefer Coban or vet tape to that sticky stuff as it sticks to itself, not your skin. Maybe tape the big toe to the long toe and use the post op shoe and loose the outrigger? But you do you.

I hope that this is more helpful than confusing and best of luck with a rapid recovery.

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I trust nothing on the internet and wish it were easier to talk to real docs. Thanks for your insights. No one in real life has mentioned joint involvement, but two of you dentists see it so far. I'll ask at my appt.

Doc 2 taped the long toe #2 to the big toe. I retaped because that made a 20 degrees bend to the right. Taping to #3 makes it almost straight and a small rolled up paper wedge near the joint pivoted it about perfect. I have better tape for the next time. Not looking forward to peeling it off. Was hoping I'd have a 3d-printed splint by about now, or soon, but that's harder to materialize than I thought. My goal with a 3d-splint is no or minimal tape on skin, and easy access to inspect and re-splint. And less MacGyver.

Doing my best to baby this toe, and care for a chronic back that requires some movement. Post-op shoe is on 24-7 unless I'm checking toes or adjusting the splint. Big toe didn't like the skewer pressing on the nail so I bolstered it. Etc. Lying supine with about foot elevated, in a 3-sided box to keep ankle near 90 degrees. I crawl, crabwalk, or use crutches to move.

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Originally Posted by jerlane

Lots of medical advice here from non-medical professionals, but I guess that’s the TGR way!

Yes, the blood supply to the bone is within the bone and can be disrupted with certain fractures. Loss of vascularity (leading to non-union, or AVN)can be a risk with certain fractures ie Jones fracture of the fifth metatarsal or scaphoid.
I don’t think that is a big risk for this fracture. The bigger concern is the degree of instability. Will the fracture stay put long enough to heal? If it keeps displacing the way you described it initially is a bit concerning. I’m definitely impressed with your Franken-splint!


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Given the toe was flopped over 45 degrees, Imma guess any internal blood supply was severed. Dunno if that's the same as disrupted - the parts are together again now, and I think the splint is good, meaning two days of minimal motions, besides jarring the shoe and muscle twitches. I also habitually tense the top tendons on my foot.

I also think the prior buddy splint was reasonably good the two prior days. At the appointment, we carefully untaped it (doc let me do it). Then she buddy taped to big toe which caused it to bend 15-20 degrees in the direction of the flop. When I got home, my sister and I started MacGyvering on the left foot (guinea pig!), then made the right foot splint pictured above.

It's not especially painful, and there were no pain spikes removing or adding any of the splints so far. Dunno if that's good or bad. I'd guess the initial and repeated 45 degree flops mean the distal bone fragment of the fracture likely lost its nerves too, but the rest of the injury ought to be innervated (plugged in and sending pain). Those eventually grow back I hope. The toe tip has sensation and is as warm/pink as the others. The most recent 45 degrees flop was leaving x-ray 2 hours post-injury.

Thanks for the splint compliment.

The only advice I can add is do not ride the subway while your toe is healing. I had two broken toes on the mend and after two weeks a large person stepped on my foot when the subway car lurched. Back to square one with the toes.

Lesson - take broken bones to the ER.

Saw another private DPM. And got fresh xrays that look about the same. Fracture is offset as in first xray, there's a small lean to the right, and a small right-hand twist.Doc says injury should have been properly reduced in first 24 hours, but now it's straight enough that he recommends no treatment. (Also says ER docs are much better at trauma than UC docs.) Will function the same under any treatment now, with same pain outcome (some arthritis risk). Arthritis depends whether the healing process affected the joint. If I want it straighter now, he would numb and pull it, or ORIF it. I care about function, so no treatment it is.

Says X-ray does indicate for surgery, even now, but clinical does not - looks pretty straight. Rx Minimal activity. Keep babying it four more weeks. Keep the surgishoe on 24-7. Don't reinjure.

And curse managed healthcare for caring more about following process than timely treatment. Fuckers dallied and led me on the first morning, and have cancelled several appointments, sometimes without notice. Bureaucratic bunglers. "Oh that opening didn't really exist, should not have been scheduled" Or we cancelled that bc "you can only have one DPM" never mind the referral from the first to second. Feels like they're gaslighting me, but maybe they just bungle a lot, make promises that someone else breaks.

Did they rec PT once you can get out of the shoe and flex the foot? I broke pinky several years ago. 10 wks with foot immobilized. Once for the thumbs up to begin regular activity, the doc didn’t mention pt. I went about regular athletic and life stuff. Come winter, I started having upstream problems (knee). Saw a physiatrist who dx’ed issues from leg atrophy from the immobilization 9 months prior. It was visually noticeable once pointed out to me. PT set me straight.

It's the farthest extremity from your core and there's is barely any tissue around that bone so they can be real slow to heal not to mention they are real easy to continue to re-injure during the process. I swear it's like a broken tow is a magnet for table and chair legs. At 48 years old I don't expect any broken bones to be put on the fast track for healing. The body just doesn't do that anymore.

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Originally Posted by bodywhomper

Did they rec PT once you can get out of the shoe and flex the foot? I broke pinky several years ago. 10 wks with foot immobilized. Once for the thumbs up to begin regular activity, the doc didn’t mention pt. I went about regular athletic and life stuff. Come winter, I started having upstream problems (knee). Saw a physiatrist who dx’ed issues from leg atrophy from the immobilization 9 months prior. It was visually noticeable once pointed out to me. PT set me straight.

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Thanks, I'll be watching for that. I've seen exercises online. Seems like one doc thought I'd been walking around this whole time, and should walk on it, in the post-op shoe or a regular shoe if I can get into one. Toe doesn't like me standing unweighted for more than a few minutes. It becomes painful and swells. Other doc says minimum activity, stay home for 4 more weeks. His main concern seems to be I'll reinjure it. I'm leaning in that direction. Dr. Google says these two docs are on opposite ends of the activity spectrum, with first the extreme one. I see that more activity lessens the atrophy risk.

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Originally Posted by raisingarizona13

It's the farthest extremity from your core and there's is barely any tissue around that bone so they can be real slow to heal not to mention they are real easy to continue to re-injure during the process. I swear it's like a broken tow is a magnet for table and chair legs. At 48 years old I don't expect any broken bones to be put on the fast track for healing. The body just doesn't do that anymore.

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Thanks. I'm a few years older, and have moved most of the chair legs now. And I'm almost always buddy taped and wearing the post-op shoe. Before breaking one, my toes also seemed magnetic - guess I missed the signal to up my shoe game and drop the sandals and barefooting.