#826 How can I tell if I should have surgery to remove a big toe fracture fragment? - DOC

#826 How can I tell if I should have surgery to remove a big toe fracture fragment?

How can I tell if I really need to have surgery to remove a fracture fragment in my big toe joint? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



If you get a fracture in your big toe joint and you have a piece of bone in there and you see it on the X-ray, the chances are really good that you’re going to want to have it removed. The reason I know this is I’ll tell you a quick story.

I basically one time in my office, I took an X-ray of my foot after I’d had the X-ray machine recalibrated. And when I looked at the X-ray, I actually had a huge fracture that never healed in my big toe joint and it was inside the joint.

Interestingly, that did not cause me pain, at least not presently. But I remember specifically when I was in college, I was pulling a 45 pound weight off of the stack to get ready to do squats. And when I did, I wasn’t looking. I was talking to my friend Frank, and I pulled it off and it fell straight down onto my big toe. And of course, I tried to act like I was tough and continue to work out for a little bit and then I felt like I was going to pass out when I got up off the squat machine so I decided to go take a shower.

When I took my shoe off, it was filled with blood and my toe had split open like a ripe tomato. This is not good. I actually got lucky because that was technically was an open fracture but I don’t even know I broke it so I was too stupid even go to the doctor back then. So, I didn’t, and it turned into a non-union. Well, it’s not painful.

The point of the story though, is I took the X-ray, put it up on the X-ray viewing board, and I asked my partner, I said, “Hey, what do you think we need to do this?” And he was like, “Oh, well, you’re going to take that piece of bone out.” And then I said, “What if it doesn’t hurt?” He was like, “Is that your foot?” And I was like, “Yeah, I mean, I told him the story.” And he said, “Yeah, it looks really bad, but it’s crazy that it doesn’t hurt.”

So, number one, just because it looks bad, doesn’t mean it has to come out. Now, the other thing is that if it’s causing pain, and it’s limiting your running and you can tell for sure that the movement of that piece of bone is what’s limiting your running, yes, you might want to consider surgery, but don’t do it unless you get at least two opinions.

The other thing is that you suspect the bone is moving and irritating the tissue and the bone and it’s causing pain when you’re running and you confirm that by looking at an MRI, where you can actually see there’s inflammation within the bone fragment and there’s inflammation in the neighboring bone that it’s rubbing against and then it suggests that if you remove it, it’s going to stop that irritation, stop that rubbing, stop that grinding, calm down, and then maybe let you get back to running.

But you have to really think about this carefully. Just because it looks bad doesn’t mean you’re going to be better if you take out that thing to make your X-ray look better. The way you have to really think about this is you’ve got to shift your thinking away from being an injured athlete to being an athlete who’s going to get back to running.

The best way to do that is the injury the running injury roadmap that I wrote, you can get a copy for free at www.docontherun.com/roadmap. So go check it out and I’ll see you there.