Preventative maintenence for my way to work... Stop my toe from breaking!
November 5, 2010 8:00 PM   Subscribe

This is the second time my big toe has broken with no trauma. How do I prevent this from happening again?

YANM Podiatrist, Chiropodist, or any form of Doctor

A few years back, I went into my doctor with severe hip/knee/foot pain and it turned out I had broken the metatarsal for my big toe and was limping like crazy on my walks to school. The doctor asked me what happened, and I could recall no toe stubbing or dropping of heavy objects on my foot. He told me to chuck my shoes and got me on a physio program so that I could walk normally again.

My toe feels the exact same way today that it did just before the pain became unbearable last time. Yes, I am going to my doctor to confirm when they are open, but there's swelling and it hurts to poke it so I'm 99% sure it's busted. I know I should be doing the rest-ice-elevate thing in the meantime.

From a previous quesiton, I have small nails on my baby toes on each foot, like they "scrunch" into the rest of my toes, but I wouldn't say my feet are deformed. I walk to and from my train to work (2km each way, no incline to speak of) and have been walking the route for over a year with no major issue until this week. My regular shoes are less than a year old, and I have been rotating a couple of different pairs. Same as last time, I can't recall any trauma happening to my foot.

I love walking, it's my life! How do I prevent this from happening any more?
posted by cathoo to Health & Fitness (10 answers total) 1 user marked this as a favorite
How old are you? My mom has that problem from severe osteoporosis. In that case, there are things that can be done.
posted by sunnichka at 8:10 PM on November 5, 2010

It doesn't sound normal to me that your toes randomly break.

Please have a serious discussion with a doctor and buy a bicycle. Good luck.
posted by TryTheTilapia at 8:14 PM on November 5, 2010

Did the doctor give you an X-ray the last time it broke?

I had a bone break with no trauma (a bone in my finger, when I was lifting my handbag) and it turned out to be an enchondroma, a benign bone cyst. An X-ray detected it.
posted by Jeanne at 8:17 PM on November 5, 2010

Are they stress fractures? I get those all the time in my feet, mostly my toes, and I have since I was a teenager. Just from walking, I'm not a runner or anything. So yes, my toes randomly break and so they're a mess of bone knots. (A bone knot can evidently actually cause more breaks later on, because it strengthens the site of the previous break so much that the overall strength of the bone becomes uneven down its length and more likely to bend on either side of the knot.)

I have not found any certain solution. My doctors weren't any help, all they could basically say was "don't walk so much." I have tried shortening the length of my steps - to reduce the angle at which pressure gets applied to my feet - and avoiding hills or at least slowing down on them, and I feel like those measures have maybe cut the frequency in half.

However, the primary reason I have this problem is that I'm large and heavy (300 lbs.) so if you aren't the same way it's probably a different problem. (Though maybe something similar, like could you have been carrying something unusually heavy for example?)
posted by XMLicious at 8:30 PM on November 5, 2010

my very random advice to you, in addition to talking to your doctor, is to ask your doctor to test your level of calcium, to make sure that it's normal. if its even slightly elevated, you could have parathyroid disease, which is curable, but reasonably rare so your doctor might not pick up on it. one of the ways its found is when someone's bone breaks unexpectedly.
posted by saraindc at 2:21 AM on November 6, 2010

my very random advice to you, in addition to talking to your doctor, is to ask your doctor to test your level of calcium, to make sure that it's normal. if its even slightly elevated, you could have parathyroid disease, which is curable, but reasonably rare so your doctor might not pick up on it. one of the ways its found is when someone's bone breaks unexpectedly.

Also, a test for parathyroid hormone. But your doctor (or endocrinologist) should know that a blood calcium test isn't always useful by itself. Your body is (usually) really good at keeping your blood calcium levels normal, often at the expense of your bones.
posted by cabingirl at 10:25 AM on November 6, 2010

FYI there is a so called "bone scan" (wikipedia) and some other diagnostic tests you can have done to your bones (discussed in the wikipedia article) that you can have done to determine any past fractures, how any conditions such as osteoporosis are affecting your bone density, etc etc. So if you're concerned about this, you might ask your physician for some followup along those lines.
posted by flug at 10:23 AM on November 7, 2010

XMLicious, it was the same toe as before, so I'm hoping that you're on the right track.

I'll have a sit-down with my doctor to discuss other tests.

Thanks everybody!
posted by cathoo at 4:04 AM on November 8, 2010

I think sunnichka is right that you have osteoporosis.

But you are a young woman. Why would you have osteoporosis?

I looked over your posts and found something I think could *possibly* be at the root of the matter. It's kind of complicated and quite speculative, but it does tie together several things you've mentioned in the years you've been a member.

In the first place, osteoporosis is often associated with metabolic acidosis. Essentially, if you are more acid than normal, your bodily fluids will dissolve mineral out of your bone the way vinegar will dissolve the surface of a marble countertop.

Now here comes the big speculative leap. back in January, you answered the question of someone who had what seemed like episodes of food poisoning when no one else was getting sick and wanted to know what could be going on.

You wrote

I had a similar thing. Eggs and fat would trigger it, and it would build up. For example, if I had eggs for breakfast, cheese at lunch and a fatty dinner, there would be a problem in the evening. Either one individually wouldn't cause a problem.

After being in the hospital to be rehydrated after one particularly bad time I actually went to my doctor about it. My doctor said it was more like gall bladder "silt" than "stones" according to the ultrasound. He said cut down on the processed junk and fatty foods, and it has helped dramatically! I also keep more focus on what I'm eating, and skip the creme brulee for desert if I had a 3 egg omlette in the morning.

You have "silt"-like gallstones and food poisoning-like episodes which are not associated with ingestion of any pathogen.

Salmonella is notorious for becoming a chronic infection in about 3-5% of the people who come down with a case of food poisoning, and its favorite place to hide out is in the gall bladder incorporated into gallstones.

I think some version of this is probably happening to you.

Gallstones are variably composed of cholesterol and calcium carbonate.

Just as vinegar will dissolve the calcium carbonate of the marble countertop, acidic body fluids will tend to dissolve the calcium carbonate of gallstones, and presumably expose the salmonella hiding there to attack by the immune system, but occasionally at a cost of giving you what feels like an episode of food poisoning.

I would speculate that you have osteoporosis due to metabolic acidosis, and that you have developed metabolic acidosis in order to help control a chronic infection (probably salmonella) hiding out in your gall bladder.

I think the combination of two foods necessary to trigger one of these episodes in you supports this view: the protein in eggs causes the stomach to produce a lot of acid, and the fat of the creme brulee causes the gall bladder to release its contents to emulsify that fat, thereby exposing the gall silt to the stomach acid.

Now, one way for your body to become more acid is to develop chronic sleep apnea, which I find particularly interesting in light of an answer you gave back in 2007:

As a mid-twenties female myself, I've found that I need *more* than 8 hours a night, more like 9. Remember 8 hours is the average amount of sleep that a person needs. Some need more (like me) and some need less. At 6-8 hours I wake up grumpy and miserable. That little bit of extra time in bed lets me wake up gradually & happy.

If salmonella in your gall bladder is the root of your problem with fragile bones in your toe, as I am guessing, I'd bet most people would say remove your gall bladder, but if I were you, I'd give antibiotic therapy a try first.
posted by jamjam at 12:24 AM on November 10, 2010 [1 favorite]

Oh, here is the link I meant to include to an article which mentions that metabolic acidosis can often be a feature of acute, as opposed to chronic, salmonella infection.
posted by jamjam at 9:43 AM on November 10, 2010

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