Toe and forefoot fractures often result from trauma or direct injury to the bone.

Did you know that almost one quarter of all the bones in the human body can be found in the feet? All these bones work in harmony to keep us on our feet and moving. And, when a bone is broken or fractured the results can be very painful, but usually not incapacitating. Most of the time, injuries to the toes (phalanges) and forefoot (metatarsals) heal just fine without surgery.

Fractures of the toes and forefoot are often the result of a direct blow. They can also occur as an overuse injury resulting from repetitive stress that commonly happens in athletes during high-impact sports like running, football, and basketball.

The importance of treating a foot fracture

The most common symptoms of a fracture are pain and swelling. This can be accompanied by bruising or discoloration as well as pain with walking or when standing on the affected foot. Seeking treatment for these types of fractures is very important because left untreated it can lead to chronic foot pain and arthritis which can interfere with the ability to walk. Lingering foot pain also can change the way a person walks and over time, that can lead to painful calluses on the bottom of the foot as well as other issues.

Stress fractures of the foot

Stress fractures happen more often in the bones that extend from the toes to the middle of the foot (metatarsals). Stress fractures can occur as a result of an unusual surge in physical activity, such as walking, running or jogging for longer distances or times than normal. It can also happen due to improper training techniques, and when a person changes their usual training modality. Sometimes stress fractures are related to the shape of a person’s foot, an overly tight calf muscle or heel cord (Achilles), and even nutritional factors.

Serious fractures of the foot

Traumatic fractures on the other hand (or foot) typically result from a sudden force like a fall or when a heavy object is dropped on the foot. It can also happen from a twisting injury. Fractures that do not break through the skin are called closed fracture.

Several types of fractures can occur to the forefoot bone on the side of the little toe (fifth metatarsal).
An avulsion fracture or “ballerina” or “dancer’s” fracture” refers to the pointe position that ballet dancers assume when they are up on their toes. Ballet dancers may break this bone during a misstep or fall from a pointe position. An ankle-twisting injury may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is called a Jones fracture, which occurs near the base of the bone causing a interference in the blood supply to the bone. This injury may take longer to heal or even require surgery.

Typical Treatment Options

Luckily, most broken toes can be treated without surgery. Initially after injury it may be painful to bear weight on the injured toe. While the injury heals it may be helpful to wear a wider than normal shoe. Taping the broken toe to an adjacent toe can also sometimes help relieve pain while the injury heals. In rare instances, when the fracture is severe, the toe may require full immobilization to protect it from further injury.

In more severe injuries of the foot where the bone is out of place and the toe appears deformed, it may be necessary for an orthopaedic specialist to manipulate or reduce the fracture. When several metatarsals are fractured in the same injury and if the foot is deformed or unstable, surgery may be required. Less severe metatarsal fractures can be treated with an initial period of elevation and limited weight bearing. This is followed by gradual weight bearing, as tolerated, in a cast or walking boot. Surgery is not often required.

In the case of an avulsion fracture where a large, displaced fracture fragment has occurred the orthopaedic surgeon may then need to do an open reduction and internal fixation with plates and/or intramedullary screws. The appropriate treatment for any injury depends on the location of the fracture, the amount of displacement (shifting of the two ends of the fracture), and activity level of the patient.

The forefoot and toes typically heal quite slowly, often requiring months to heal. In the toes, swelling can continue for a long time even when patients are not having other symptoms.

Mark E. Schakel, M.D.

As an orthopaedic Surgeon and Director of The Foot & Ankle Program at SRO, Dr. Schakel treats problems of the foot and ankle. Dr. Schakel is the director of Santa Rosa Memorial Hospital’s Foot and Ankle Trauma Service. He has extensive experience in treating problems of the foot and ankle, including reconstructive, traumatic, sports-related, and congenital problems. Learn more …