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September 4, 2018 6:01 PM   Subscribe

YANMDFilter: Are my toes broken or not?

Nearly a month ago, I very badly stubbed/jammed two toes (II and III, right foot) "head-on" when trying to clear a large rock while running barefoot on the beach. It was damn painful, but I finished the run, as I was with a friend, and we were only about a mile and a half from the end.

Later that day, they turned a nasty purple color. I could still flex them, but it hurt like crazy, so I went to a walk-in clinic (I have no health insurance, for Reasons). The doc did an exam, took a few X-rays from different angles, and told me they were not broken, although in his words, "you did a good job trying." He didn't have any advice about follow-up care, taping or bracing them, etc., just sent me on my way.

Well, it'll be a month in three days, and toe II is still significantly swollen in the metatarsal area. The whole toe beneath the knuckle is fat with swelling, although it's not discolored. It still hurts when I squeeze/flex my toes really hard, but basic everyday use is mostly tolerable. So, assuming I don't want to cough up another $110 plus additional for X-rays, does it sound like there really was a break or fracture of some kind? Or does a bad sprain/jam just take a really, really long time to heal?

(I'm mostly curious about the swelling, as that sounds like something that should have subsided by now. It doesn't seem to be getting any better. I saw this question from 2013, but my case seems to involve more persistent swelling, so I figured I'd take the risk that answers may end up the same.)
posted by mykescipark to Health & Fitness (8 answers total)
I am not a doctor of any sort, but I am a person who breaks at least one toe a year. My most recent one hurt for a month or more, but the swelling and discoloration had gone by then. As someone with a history of broken toes, it sounds like what you had might have been some sort of fracture, so going back for additional x-rays wouldn't be a total waste. (A coworker recently broke a toe that wasn't spotted until a second set of x-rays.)

That said, except for what they've already told you to do -- the taping -- there's not really much treatment for a broken toe, unless they put you into some sort of boot. You could try to make things better by changing the shoes you wear (it's always sandals for me).

Again, not a doctor, but: Another round of x-rays might find the remnants of a fracture, but unless you broke it so badly that they'd have to pin it back together, there's probably not a lot they can do for it.
posted by mudpuppie at 6:13 PM on September 4, 2018

I sprained a finger in February - x-rays confirmed it wasn't broken, but it was swollen for at least a month. Today, it is about 95% recovered, but still gives me a twinge and doesn't bend quite as far as my other fingers.

For my finger, the doctor recommended some buddy taping, also alternating soaking in very warm/cold water, to stimulate the capillaries.
posted by mogget at 6:19 PM on September 4, 2018

I'm not your doctor, just a serial stubber who has lost multiple toenails. Every time it's happened, I've spoken to doctors (and once, professional dancers). They all told me not to bother with x-rays, just to splint/tape, ice, and elevate until swelling subsides. You do this daily over the course of, say, a month. It throbs a lot, especially at night. Eventually it feels better. At that point the nail seems to be getting loose and turning black. Some time in the future--weeks, months--the nail falls off and reveals a small, unblemished newly formed nail growing underneath.
posted by Morpeth at 6:25 PM on September 4, 2018 [2 favorites]

Doesn't really matter if you broke it or not, the treatment would have been the same, i.e. not much. That swelling does sound odd, and I'd probably go to a walk-in clinic and see what the doctor or NP on duty thought about it. I'd be concerned; usually toes heal up on their own whether broken or not, but well, only usually. Seek a professional opinion as to whether it's worth looking into. They can't make you get X-rays; you're allowed to say no to things. Before they do anything that might cost money, ask them whether it's likely to indicate further treatment or if it's just to get a more specific diagnosis.
posted by Anticipation Of A New Lover's Arrival, The at 6:35 PM on September 4, 2018 [1 favorite]

Between gravity and being on your feet a lot, the swelling will take a long time to subside. I know this because I just asked my ER nurse friend about post-surgical swelling on my foot. She said, further, that anything orthopedic seems to take six weeks to heal. So take heart, and be patient. Oh, and as a serial toe-breaker, I've found that a stub hurts for a few moments but can be walked off, while the pain from a broken toe persists for several minutes without abating.
posted by DrGail at 7:22 PM on September 4, 2018 [2 favorites]

A month is quite a long time for this sort of thing to heal, but I think the key question to a decision about further investigation is whether you're seeing steady improvement. If your toe is appreciably better now than it was, say, a week ago, and seems to be getting better at the moment, then it's probably OK to leave further investigations and monitor it. But if you've been stuck in the same place for a few weeks, or a particular joint/muscle/etc doesn't seem to be improving while the others are, it seems sensible to take steps to get it looked into further.
posted by howfar at 7:42 PM on September 4, 2018

I'm not your doctor, I'm not anyone's doctor. I'm someone whose left foot seems to be cursed, however:

* I dropped a stage rapier directly onto the big toe, handle end first, while trying to juggle a handful of stage swords in the midst of putting them away.

* I stubbed that same toe a few years later while in a theater helping to construct a set.

* I twist that ankle about five times a year on average. One twist was severe enough that it actually broke the metatarsal. About three more times, it gets sprained (I am literally recovering from one such sprain right now).

* I also once knew someone who did a lot of backpacking across Asia, and learned some self-diagnosis of foot care so that if he was backpacking and hurt his foot, he would be able to assess when his own first aid was sufficient, or when he really was at a point he should try visiting a doctor.

* I also had a roommate who did a lot of martial arts and told me her own doctor-and-coach-recommended approach to treating ankle sprains, which I've followed pretty faithfully ever since and I always bounce back pretty quick. Toes, though, seem to take me a little longer.

Based on all of that:

The rule of thumb I was told was that if your toe were properly broken, the discoloration would be lasting longer than just a couple days. So since your toe isn't discolored, that suggests it's not a break. Buddy taping is all that would happen anyway, even if it were broken.

The swelling at this stage doesn't sound that concerning either; especially since it sounds like you've been walking around on it. My current sprain was on Saturday (three days ago) and my ankle is still swelling in the evening; however, I'm pretty sure that the continued swelling has to do with the fact that I a) finished the hike I was on when I first had the sprain, and b) I am actually walking on it as opposed to sitting on my ass. The less you do, the less stress you put on the injury and the quicker you heal. Since you say that you finished your run after stubbing your toe, and it is unclear whether you did any home care afterward, I'm not that surprised there's still swelling.

Have you been trying to treat the swelling in any way? Ice and compresses, as well as rest and elevation, are the recommended treatment. My roommate also recommended ibuprofen-based pain relievers, since that brings swelling down as well. But definitely do more of the R.I.C.E. approach (rest, ice, compression, elevation). It's not clear you have been, and if you haven't, that's probably delaying things.

...A month actually sounds about right, especially if you've been trying to "walk it off". My own stubbed toes were good and sore for about that long, even though they were just badly stubbed; any sprains in my ankles tend to still be sore and a little stiff for a couple weeks too. There's improvement in the first couple days, but some symptoms linger a while.

The kind of break where you'd need the RoboCop boot is pretty different. You'd have known if it was a more severe break, and so would your doctor.

Good luck.
posted by EmpressCallipygos at 7:56 PM on September 4, 2018

I would have a trusted massage therapist give the whole leg a good flushing out type of massage, with added mobility work on all the joints in the foot. Since it doesn't seem to excessively hurt when you touch the toes, they might need a bit of moving around to help the swelling go down.
posted by computech_apolloniajames at 8:34 PM on September 4, 2018

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