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Forum Name: Bone trauma and fractures

Question: Big Toe problem


 swifteye - Sun Jan 16, 2005 7:59 am

About roughly 3 months ago I fell down a few steps on a staircase, landing on my feet but with the big toe of my left foot facing downwards which jarred it badly. It ached constantly for the next 8 hours or so until I got some painkillers, after taking the next two days off as I couldn't walk well enough I visited a hospital, where they told me they wouldn't take an x-ray because had it been broken or not due to it being a toe, there would be nothing they could do. They strapped my toe with some tape and bandage and sent me on my way.
After about two weeks my walking greatly improved, and after a month it was more or less completely normal, the only problem being that I could not bend my big toe at the second joint at all. The first joint seemed fine, but i was physically unable to move my toe along the second joint. It would actually bend, if i took it in my hand and moved it manually, but i couldn't bend it otherwise. My toe did bruise visibly for a time, and to touch it was never particularly painful, and moving it with my hand wasn't either, but like I said walking for a while was particularly painful. Anyway, after a few weeks I was still worried and visited a doctor who gave me some anti-inflamatory tablets which i took for a few weeks. Slightly over a month since the accident, I managed to put a lot of weight on my toe by accident which seemed to set it back and made it more painful than it was to begin with, however this seemed to be temporary as it cleared up once more within about a week. 3 months on, I can walk perfectly, and I think even jogging would be ok, but, I still cannot bend my toe at the second joint without forcing it by hand.
I'm guessing it's to do with muscle damage rather than bone damage, as having broken bones before they're usually painful to touch and definitely to move, whereas this is not so much, and of course bone injuries typically clear up after 6 weeks, whereas this has been now more like 12. Also, i've shyed away from moving my toe by hand, but i've noticed lately when I have it does hurt slightly to bend it, like an ache rather than a sharp pain. This is all pretty worrying considering how ambiguous what is actually wrong with it is, the hospital and doctor not taking a great deal of interest, and considering how long its been without being able to bend my toe along the second joint at all. It's a big problem because I don't know when it's safe to excercise fully again, as it was excercising that made it far worse after I thought it was ok the first time.
I might add that I think ever so slightly I can bend my toe along the second joint slightly now, though I may just be imaging it, as it may have always been like that since the accident.
Thanks
 Dr. A. Saif - Mon Jan 17, 2005 3:32 pm

User avatar Hello Swift eye,

Most toe injuries are as you see managed quite conservatively, and indeed an X-ray rarely changes any decision that is actually taken. Quite understandably you feel that, "its all very well saying the management is the same, but it would be nice to know if...etc".

I presume that every thing is undisplaced, or now you would have mentioned a wonky toe. The way i would classify your injury, in the absence of any extra information is firstly either you have broken it or you haven't, and if you did break it, it either involves the joint or doesn't. Secondly, there is a soft tissue injury...we accept that, but either this involved a musculosketal soft tissue (ligaments, tendons, joint capsule) or doesn't.

Most bony injuries of your big toe heal sponateneously, without any intervention by about 4 to six weeks as you say, although X-rays may show signs for several more months after that. Joint capsule and ligamants in your toe will also take around the same time to heal. Tendons (and by the mechanism you describe, the extensor tendon of your big toe, could be damaged) also heal, but unless immobilised may heal long ...we will talk about it later. The healing process involves the generation of scar tissue,..the body's glue that sticks broken and torn bits together. This scar tissue, or fibrosis, is not as supple as your normal tissue, and if toccurs at close proximity to a joint, it leads to stifness, and pain when the joint is moved for sometime after the tissues have healed. This stiffness is more likely if the fracture involved the joint, or the injury involved the joint capsule. In fact by the mechanism you describe, it is probable that the joint capsule was involved. How long this stiffeness and discomfort lasts is difficult to predict, but if there was a fracture, and it involved the joint surface it may last( to a lesser extent than it is at present), for some considerable time.

Another injury I alluded to in the last paragraph (but unlikely in your case), is an injury to the extensor tendon of your big toe. If this was damaged then the mechanism that allows you to straighten your big toe fails. You may be able to flex (bend the toe) at the joint nearest to the tip of your toe, but be unable to straighten it. You seem to suggest that your toe is straight and that you are unable to bend it...so this probabaly doesn't apply to you.

So the treatment now...after 12 weeks, you should do gentle stretching exercises to get the toe moving. you wilol probably get good days and bad days, but gradually there will be more good days than bad. If, after another month or so, it is still giving you jip...it may be worth being referred to your friendly neighbourhood orthopod...but chances are that you will be cured by the time your appointment comes through, mate.

Cheers

saif
 swifteye - Tue Jan 18, 2005 3:08 pm

Thank you very much for the prompt response.
I'll clarify that my toe is straight, and I cannot bend it along the second joint. I describe second joint as the joint closest to the tip of my toe. The joint after that, connected to the rest of my foot if you will, seems fine.
I also forgot to mention swelling for quite some time around my toe and foot, which has seemed to subside. I did wonder if i had displaced my toe, as sometimes I think that it doesn't look quite the same as my other big toe, but I think this is me being paranoid, and obviously that they wouldn't be entirely identical anyway.
I thought perhaps though that the fact that I can bend my toe at the joint if I use my hand may be an indication that it isn't displaced? I can say that immediately after the accident I lost my ability to bend it, if that is any help.
After having so many breaks before I'm fairly accustomed to knowing how one 'feels' as such, which is why I've thought more towards it being muscular rather than a bone problem, it not seeming like the rest. Though I suppose all breaks are different to some extent.
It seems that even now it only takes a slight bump for my toe to be painful, if only for a minute, which I thought perhaps was a sign of it still being 'unhealed' or weak.

Thanks for the information, I'm not sure if what I say here has narrowed down the options any.
 Dr. A. Saif - Fri Jan 21, 2005 10:20 am

User avatar Dear swifteye,

I guess you know what your talking about being, by the sounds of things, fairly accident prone :) , comments I would make are:-
If there was a fracture and it was intra-articular, you may have stiffness for some considerable time afterwards. But in this case usually both active and passive (using your hand) movements are painful. It may reamin tender when knocked for some many months as well
If there was a capsular injury, as is the most likely, the toe remains stiff, and painful to knocks, but both active and passive movements are possible. You did mention that you were starting to be able to move the toe actively...so I will assume that the tendons governing the movement are intact. If they were not, then loss of active movement of the toe would be permanent and absolute. Pain itself is usually not a feature for established tendon rupture.
Fractures that do not involve the joint usually remain tender when knocked while the bone is not fully united. Movement is not usually affected after 4 weeks or so from the injury.
In addition to these other non-musculoskeletal soft tissue injuries can reamin tender after all the mechanical structures have healed. This could potentially lead to inhibition of the muscle that work your toe...essentially this is a subconscious reflex that prevents you moving a joint that might hurt...even though passive manipulation suggests that it would not. This is recognised in other joints such as the knee...but I guess it could happen elsewhere.

Regards

Saif
 swifteye - Sat Jan 22, 2005 1:18 pm

Thanks for the response

I guess i'll just have to wait and see, i'll do some excercises. It's just pretty disconcerting; not being able to move it actively at all (I don't know that there has really been any progress there) after 12 weeks. Hopefully it'll start moving again sometime, just that excercising a while after i had the accident originally undid a lot of the healing as it must not have been ready for it, which I don't want to repeat. I've generally been estimating that a safe time to start using it fully in excercise again would be when it starts bending again, hence it not moving seeming like such a problem.
 mail2sax - Wed Mar 16, 2005 8:19 pm

I have a similar problem to this, but related to an ankle (fibula) fracture. I had surgery three days ago to place plates around the fibula and three screws (one through to the tibia, the other two holding the plates). They kept checking the toes after surgery for bloodflow, etc, and everything seemed fine. Now that the pain and swelling is fading a bit, I now see that my big toe will bend down at both joints, but will not straighten at the 2nd joint. There is only a minor ache when I force the toe to move that is mostly at the top of the toe near that joint, but also seems to run along the top of the foot into my ankle. There is also a little bit of a tingling feeling on a small part at the outside of the toe. Should I be concerned? At this point I find it hard to focus on anything other than the ankle, but if there's something I should do to prevent future problems, I'd like to know it!
 Dr. A. Saif - Sat Mar 19, 2005 11:45 am

User avatar Hello Mail2 sax,

If this happened just a few days ago, then it is not too unusual. The filbula is normally plated with 6 screws, and somethimes one screw goes across to the the tibia and is called a diastasis screw. The big toe is normally spared by surgery around the fibula (the fibula being on the outer side of the leg, and the tibia is on the inner side). Numbness and tingling can follow surgery to the fibula, but gain this normally involves the sural nerve, and is usually along the outer aspect of the ankle and foot.

I would guess that this is too early following the injury to make judgements about the mobility of your toes, and the long term implications of this tingling. See how it develops over the next week or so...

Regards

Saif
 mail2sax - Sat Mar 19, 2005 5:18 pm

Thank you! Oddly enough, I suddenly re-gained nearly normal flexibility in my toes since I made that post a couple of days ago. I'm assuming it was related to the swelling, which also seems to have subsided somewhat. Still having considerable ankle/incision pain when I stand up...but I understand I'll have to live with that for a couple more weeks.
 Margaret Templeton - Wed Jul 06, 2005 11:09 am

Along the line of the previous posters.

I am a 72-year-old female who had bunion and hammer toe surgery in 1982. I had no problems until 1996 when my surgery area became inflamed the big toe and bunion site were red and swollen, I could not put my foot to the floor. There were large water type blisters along the surgery scar. My doctor at the time could not come up with a diagnosis for the problem but prescribed antibiotics. After several months the problem just healed itself.

On July 4, of this year the toe again has become inflamed and swollen, again the big toe and bunion area are involved again I cannot wear a shoe. There are no blisters, the toe is very red and the only thing that seems to help is ice. I keep the foot elevated for the most par and try not to put any weight on it. I am perplexed as to what this might be. I understand that I could have injured the toe in some way?

Thank you for any help you may be able to provide.
 Margaret Templeton - Sat Jul 09, 2005 11:19 am

I saw my doctor after posting to this board. An aspiration of the large toe area was performed and the diagnosis is Gout. Irony of the story is I have always followed a low fat diet (per my doctor’s advice) and I don’t drink alcohol. Oh well, another of life’s challenges. Thank you to anyone who read my prior missive.
 NOS - Thu Aug 04, 2005 1:51 am

:?: :?: :cry:

I was wrestling and i kicked my selft up and instead punched the floor with my big toe and now it is bery stiff and there is a ring of purple around the middle toe and i cannot feel anything above thd bruise.

I work in a active job but must return this weekend and i cant walk but do not want to be fired. It seems you have as much knowledge as a good doctor so i assume you are one. If you agree that this is a true injury(that i can prove in person or by photo) would you be able to write me a doctors note?
 NOS - Thu Aug 04, 2005 1:59 am

some years ago i fell from my rooftop onto my tailbone and feel my neck and tip of tailbone ache. after sitting for long periods of time, when i flex my pelvic muscles my talbone hurts. I have not grown very much in a while, i am 17. should i go to the doctor
 toe_bash - Sun Dec 04, 2005 10:47 am

My problem is similar to the first posting. I engage in martial arts and over the past months have suffered some impact to both big toes, more specifically around the top of the big toes at the joint closest to the tip. The result is immobility of that joint, particularly on one foot, when I try to either move it by itself or through manual manipulation.

Visited by GP about it this week and what he told me worried me. He says that I have developed bone spurs near the joints, have some arthritis and that on the least mobile toe, I have probably also lost some cartilege. He offered that there was no therapy I could engage in for this problem. Furthermore he told me that I must not hit my toes again! This is simply not realistic if I am to continue with my sport as I intend to do. Is there truly no therapy I can engage in? Aside from the lack of mobility at the joints, I do not have sympoms but do experience quite a lot of pain when I do hit this area as I do on occasion. Mainly I am worried about this Dr's diagnosis. Thank you.
 pantera - Mon Apr 20, 2009 3:25 am

I also do martial arts and had the same problem. i stopped for about 6 months and played some soccer wich didnt really bother my injury but now back on the mat every time my toe bends down I feel a light pain that lasts for about 10 min. (more or less) Pain lasting also depends on how much I bend my toe too. I went to the doctor today and he told me to put ice 3 times a day and quit everything (martial arts, running, even walking), he also told me to sit at work wich I cant really do cause Im a server on a restaurant. They also suggested to get ultrasound and therapy but I don't have insurance and I cant afford the threatment. now, my question to the doctor was: why I didnt heal during those six months that I didnt really hit or bent the toe? he told me that I didnt really gave it a chance to heal because of using the toe to walk around and the better way to get well is to put a cast on my foot for 4 weeks to fully recover. I don't really want to go there because I cant afford to stay home for that long doing nothing and sounds crazy that just by walking Im affecting the healing process. is there any other opction for me? I almost forget, they took x-ray's and he said bones look very good and most likely is a soft tissue injury but he didnt know if it was musculas or tendon. PLEASE HEEEEEELP this is very frustrating!!!!

how are you doing with you toe swifteye? any recomendations?

thanx a lot !
Diego
 Tom Plamondon PA-C - Thu May 14, 2009 11:35 am

User avatar Hello,
You may have a mild form of turf toe. Turf toe is an injury to the metatarsal phalangeal joint. In severe case, the joint dislocates; in mild cases the joint capsule (tissue which connects the two bones of the joint), is sprained or stretched.

You may be able to splint the toe rather than casting the foot. This may allow better mobility.

Ice and NSAIDS may also help.

Take care and let us know how it goes.
 Mytoe - Wed Nov 18, 2009 9:59 am

I have almost the same problem as stiffeye but the difference is i cant bend the second joint of my toe at all. i cant bend it even with my fingers. my toe bone was actually dislocated while playing. the doctor used anesthesia near my toe then using his hands he starighten my big toe to its correct position. i had bandage aroung my big toe for 1month till ididnt recover. i recovered but after that the problem occured. i can bend my first joint properly -upside as well as down. pls pls help
 Mytoe - Wed Nov 18, 2009 10:02 am

I have almost the same problem as stiffeye but the difference is i cant bend the second joint of my toe at all. i cant bend it even with my fingers. my toe bone was actually dislocated while playing. the doctor used anesthesia near my toe then using his hands he starighten my big toe to its correct position. i had bandage aroung my big toe for 1month till ididnt recover. i recovered but after that the problem occured. i can bend my first joint properly -upside as well as down. pls pls help
 dirty no good rotten - Sat Jun 12, 2010 7:17 pm

The base of my big toe has been hurting for a week. I think it is turf toe or a sprain. I did not hear a snap because I ware head phones when I run. I can't pin it down on running but I have been doing a lot of running. I wear new balence cross trainers, the ones on sale for fifty dollars. No proublems before I started doing 6 miles in one hour. Felt minor proublems in same foot, kept running. Never realized it could get so bad.

My symptoms are a constent acccute pain in the left ball of my foot, unnoticible sometimes. I work on my foot for eight hours at a time. I am limping by the last four hours of my shift. Range of motion does not seem to be changed, no bruseing, change of color etc. I can walk fine at a slow pace. Sometimes the phone rings and I walk too fast and feel pain. I think it is a mild form of turf toe brought on by running on a tred mill in old sneakers. What do you think?
 vab - Thu Jun 24, 2010 11:41 am

I have a BIG TOE problem as well. As a dancer, I have used my feet tremendously. About 3 months ago, in typical dancer clumsiness, somehow I landed after a movement with my toes being bent under or jammed with the top part of my foot and especially my toes hitting the floor hard. The immediate result was excruciating pain and inablility to walk normally, some swelling and some bruising. Long story short, today, my big toe still hurts. The rest of my toes and foot are fine. I am an avid hiker as well and can, for the most part, continue this exercise. But I can't use my foot in dance-yet. Reason being is that the joint closest to the foot (as in standing on your tip toes) hurts and pointing my toes hurts my big toe and the big joint on the outside of the big toe hurts when I push on it. Sometimes I will simply get a pain through the big toe when I am doing nothing - maybe arthritis? Any opinions/help appreciated.

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