What are the basic steps if you have a broken toe, it’s crooked and you want to put it back in place? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
There really are three basic steps that doctors use when you have a broken toe and the actual clinical or medical procedure name is called closed reduction, meaning we don’t cut it open, look at the bones and put them in place but we leave the skin closed and we just manipulate it and pop it back in place.
This is a very common procedure doctors do, I have done it many times at people’s homes when I’ve seen runners who have a broken toe and I’m going to explain to you the basic steps but do not do this on your own. See a medical professional, don’t do this, wind up with a problem and then sue me because you said I told you to do it because I haven’t even seen you and I’m not giving you medical advice. I’m just telling you what we’re taught in med school.
Now with that said, there are three basic steps and this is very, very common because broken toes are very common. If we look at the foot and we basically just draw a picture here of let’s say, the pinky toe or the fifth toe, and I know my drawings are terrible. So, you want to make a comment on how bad my drawings are. Maybe enough people will comment and you’ll feel sorry for me and I’ll be able to start a GoFundMe page to get drawing lessons or something but I’m not an artist. I’m a podiatrist and this is basically the best I can do.
So, these are your little toes, that’s your fourth toe. This will be your fifth toe, third toes over here, obviously and I’m not going to draw the rest of them. But let’s say you’re walking along through your living room and you accidentally, you kick a chair, you kick the leg of the chair as we’re walking past it, you’re walking by it and from this direction, the chair leg is here, you swing your foot into it and you whack it and you break the toe.
Well, what typically happens is that you will get a fracture that is shaped about like that in that position on this little toe. And when that happens, if you kick it hard enough, you can get what we call a displaced fracture, where it is moved out of place. When it’s moved out of place, this is what it looks like. Basically, you’ve got the base of the toe, the proximal phalanx, it’s not moved, that’s stable, so it’s stable in this part. And so, for this drawing like how this gets displaced, then basically you have the bone gets tilted over like that.
You’ve got the end of the proximal phalanx bone, this part, is tilted over. That’s what I’m trying to illustrate here. So, it’s tilted over, obviously in this direction. Why? Because of the deforming force of the fracture, the hitting the chair, the leg of the chair, kicked it over, and then your toe is crooked. So, this is the outside of your foot and the toes crooked like that. It’s bent outward and then you have the intermediate phalanx and the distal phalanx in the toenail, but the toes pulled over. It’s crooked.
How do you fix this? Well, many people think well, you just push it back and hold it there. It’s a bad idea. You don’t do it that way. There are three specific steps that you’re supposed to do and we’re going to talk about how to do that.
Step number one may surprise you. Step one, is to actually distract the toe. So, step one, you pull the toe out, distract it. Why do we do that? Well, there’s a couple of reasons. One of them is that sometimes when the toe gets bent over like this, you may have actually the artery or blood vessel stuck in there. You may have some soft tissue like a torn joint capsule or something that is actually stuck in the fracture site if you just push it over, you’re just going to pinch off that blood flow then you can stop the blood flow to the toe again a thing called a vascular necrosis and the tissue in the toe actually dies. You do not want that obviously. So, number one, you distract the toe.
Number two, you apply a deforming force. So, you deform the toe, meaning you pulled the same direction. So, this is actually step two. You pull out on the toe, then you move it a tiny bit in the same direction it was already deformed, and that ensures that any soft tissue and stuff will be pulled out of there.
Then step three is to reduce it. So, step three, is to pull it back in that direction, and then you hold it in place. So, you have to do it in this specific order. And in most people, when they think you’re going to just pop it back in place they think it’s just step three, that you’re just going to basically push it back in place and hold it there. That’s not how it works.
It’s really important that you understand what to do because if you do the right things right away, and you get this corrected right away, you’re much more likely to have it heal faster without complications and without something called a delayed union. Because even if you don’t cut off the blood flow to the toe, if you get some soft tissue or fragments of bone stuck in there because you ground off some little chips of bone by pushing it back in without distracting it, then you can wind up with something called a delayed union. That’s where you get some junk stuck in between the two pieces of bone and it prevents it from actually healing.
You don’t want that if you want to get back to running, you’ve got to do the right stuff when you have a broken toe. If you haven’t seen it, you can go check out the broken toe masterclasses, it’s a thing I do live occasionally where I talk about broken toes, all the questions about broken toes. you can get it for free at docontherun.com/brokentoemasterclass. So check it out, and I’ll see you in the training.