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Sunday, June 21, 2015

Recommended Shoes for Broken Toes -- and how to PROPERLY treat a broken toe!

Shoe Recommendations 
for Broken Toes
and how to properly treat a broken toe!


It is a common myth that there is no treatment for a broken toes. 

Many time, I have had patients say to me, "I was told that there is no treatment for a broken toe." 

This is completely false. 

This article will tell you what to do if you think you broke your toe, what can happen if you do not get proper treatment for a broken toe and what are the best things to do if you think you broke your toe but you do not have access to a doctor. It will also have shoe recommendations that will help heal the broken toe faster and with much less pain. 

First, if you think that you broke a toe, I highly recommend that you make an appointment with your local podiatrist who will be able to evaluate and diagnose your toe pain as well as take foot x-rays, which can usually be taken in the office at the time of your appointment. 

Assuming it is a simple fracture, the podiatrist will dispense and fit you with either a surgical shoe or, if it is a more serious injury, a below the knee removable walking boot. You should leave the office feeling much more comfortable and you will decrease your chances of developing long-term side effects that can be caused by an improperly treated broken toe, which I will discuss later in this article.

Most broken bones take six weeks to heal. Stress fractures can heal sooner. Your podiatrist will be able to differentiate between an acute fracture and a stress fracture by looking at your x-rays. Whether you have a bruise, a stress fracture or an acute fracture, there is a early phase of bone healing that doctors commonly refer to as the 'golden period' of healing. This is one of the reasons why it is so important to go to your podiatrist as soon as you can after any foot injury. During the early stages after an injury (10-14 days), it is especially important that you immobilize the site of injury (with the surgical shoe or CAM walker) as well as elevate and rest your feet as much as possible. The human body is pretty amazing and if you help it out with the "RICE" method: rest, ice, compression and elevation - you will greatly increase your chances of healing faster with much less swelling and pain and you will get a better cosmetic result. 

You must be careful with icing your feet. There are some medical conditions that, if you have them, you should not be icing your feet. Anyone with a history of gout should never ice their feet as it can trigger an acute gout attack. If you have a history of Raynaud's disease, a previous frostbite injury or peripheral arterial disease (poor circulation), you should not ice your feet. If you are diabetic or have nerve damage, you need to consult your podiatrist as to whether you should be icing your feet, as it depends on the severity of your disease. You should never ice longer then twenty minutes. Icing your feet longer then twenty minutes can cause tendon and nerve damage that can cause frostbite that can lead to amputation. 

After your podiatrist diagnoses you with a toe fracture, he or she will usually make a follow up appointment in six weeks to verify that the toe has healed correctly. On the six week follow up, if the podiatrist verifies that the fracture has properly healed, he or she will have you return to wearing proper shoes and ease back into all activities. 

Occasionally, the toe fracture is so severe that you might need surgery. This is one of the reasons it is important that you get x-rays. My experience has been that the majority of toe fractures do not need surgery. To state it in rather broad terms: if you have a bone sticking out of the skin and you are bleeding out of that open wound, you probably need surgery. If you have a painful, swollen toe and no open wounds with the bone not sticking out of a bleeding wound, you probably don't need surgery. This is a broad generalization and I highly recommend that you get proper evaluation and treatment from your local podiatrist - or the ER doctors!

If a broken toe is not properly treated then these complications can occur: 

1. Sausage Toe. As the name implies, a 'sausage toe' is a red, hot, swollen toe that is chronically painful as well as cosmetically unpleasing. 

2. Non-Healing Fracture. If a toe is not properly treated or if there are underlying medical issues such as diabetes, poor circulation or osteoporosis, a simple toe fracture can develop into a non-healing fracture, which means it remains chronically unstable and simply won't heal. This can be difficult to treat and lead to chronic pain, swelling and, in some cases, amputation. The best way to prevent a non-healing fracture is to get early and proper treatment of any foot injury.

3. Osteoarthritis. If the toe fracture involves the joint, an improperly treated broken toe can cause osteoarthritis, which also leads to chronic pain, swelling and degenerative joint changes. It also gives you the dubious advantage of being able to predict rainy weather. 

4. Toe Deformity.
An improperly treated broken toe can result in joint damage, chronic low-grade swelling and displacement of the broken bones that can cause toe deformity. The toe deformity can make it painful to wear shoes, cause low-grade pain and be cosmetically unpleasing. 

There are a bevy of other complications, but these are the main ones. 

Broken toe information for patients with diabetes and peripheral neuropathy (nerve damage):
If you are diabetic or have peripheral neuropathy (nerve damage), please remember that you may not be able to feel the pain of a broken toe. I recommend that all patients with diabetes, nerve damage and poor circulation inspect their feet at least twice a day. If you have any of these conditions and if you see any problems such as swelling, bruising, or open sores on your feet, then you need to make an appointment with your podiatrist as soon as possible. If you have numb feet from nerve damage, you can't trust how your feet feel because you can't feel pain caused by a fracture. Broken bone pain and neuropathy pain are two different things. You may have pain caused by nerve damage, but don't make the mistake of thinking that just because you can feel nerve damage pain that you can feel the pain from a broken bone. Biomechanical pain (broken bones) and neuropathy pain (pain from nerve damage) are two different things and should be treated as two different things. As a podiatrist, I can get big improvements on biomechanical pain such as broken toes, tendonitis or osteoarthritis (to name a few) while neuropathy pain is more challenging, but not impossible, to treat. 

The truth about strapping toes together as a treatment for broken toes:
For those of you who have been told to strap your toes together - here is a little known but important caveat: you can strap toes 2-3-4 together, but you should never strap the 1st toe to the 2nd toe or the 5th toe to the 4th toe. The 1st and 5th toes have different ranges of motion and if you strap them to their neighbors, it will cause irritation and increased swelling and pain. Also, if you have diabetes, neuropathy, peripheral arterial disease - strapping your toes together can cause problems such as open wounds, infection, gangrene and even amputation. 

For best results, if you want to try strapping the toes, it is crucial that you wear proper shoes. For a fracture to heal, you must have no motion through the site of injury, which is why the surgical shoe and the CAM walker are able to heal fractures. No motion through the site of a fracture means that the bones can heal faster with less swelling and pain and less chance of forming 'bone callus', which is excess bone formation caused by motion through the area of a fracture. Bone callus formation can cause permanent bone spurring that can be painful in certain shoes. For a fracture to heal, you need immobilization (no motion through the site of injury), elevation, rest and time (usually six weeks). There's no use strapping the toes if you are going to walk barefoot, wear flip flops or wear a shoe that is too flimsy and flexible. You will just be setting yourself backwards by slowing the healing rate and setting yourself up for complications such as chronic swelling, pain, toe deformity and the dreaded 'sausage toe' which is surprisingly difficult to treat. 

Advice on what to do if you do not have access to a doctor or health care and you think you broke your toe:
1. Get a Birkenstock sandal (with the strap in the back) and wear that as much as possible. Birkenstock sandals have a rigid-sole and an open toe, which will allow for decreased motion through the site of the fracture. It is very important that you purchase the sandal that has the strap to the back as that will help prevent the toes from scrunching down to stay in a backless Birkenstock. Any extra motion through the toes will cause more swelling and pain and will slow the healing process. Click her for pictures of what a Birkenstock sandal looks like:
http://www.amazon.com/Birkenstock-Milano-Slingback-Sandal-Softbed/dp/B000JLMEJU/ref=sr_1_25?s=apparel&ie=UTF8&qid=1436043519&sr=1-25&keywords=birkenstock+sandals

2. REST. Nothing speeds up healing and decreases pain more than just good, old fashioned rest. 

3. Whenever you are at rest, elevate your foot above heart level as much as possible. Elevation helps decrease swelling, which helps with decreasing pain and speeds up healing. 

4. Ice (on and off) for 5-10 minutes per day. Use a bag of frozen vegetables for 5-10 minutes at least twice a day. You can ice in increments of 5-10 minutes as many times as you like as long as you are not icing continuously. If you are diabetic, have nerve damage, poor circulation, Raynaud's disease, a history of frost-bite or gout - do not ice your feet. 


MBT (Rocker-Bottom Soled Shoes)
http://www.amazon.com/MBT/b?ie=UTF8&node=2596297011

Rx Crocs Ultimate Cloud (with the strap to the back)
(Use the 20% Coupon link in the upper right hand corner of the blog)

Rx Crocs Relief (with the strap to the back)
(Use the 20% Coupon in the upper right hand corner of this blog)



For a shoe to be comfortable when you have a broken toe or are recovering from a broken toe, it must meet four criteria:
1. Thick, rigid and completely non-flexible sole
2. Wide toebox
3. Rearfoot control, so the toes aren't gripping down to stay in the shoe
4. Arch support


Once again, if you think you broke a toe (or broke any bone in your foot), please make an appointment with your local podiatrist. If your podiatrist is recommending surgery, there is nothing wrong with getting a second opinion. Most foot fractures do not require surgery and can be successfully treated with immobilization, rest and elevation.  

*** 

For more articles on painful feet and proper shoes, please check out my articles:

My feet hurt: top ten things to do to alleviate foot pain today.

Shoe Recommendations for patients recovering from Lisfranc's fractures.


***

I hope this was helpful and, if you want to thank me, please refer any 'limpers' in your life to my blog or, if you love detective novels, check out my novel 'Gunning For Angels' on Amazon. 


Thanks for reading and have a great day!

Dr. Cathleen A. McCarthy

:)











21 comments:

shamsher khan said...

Hi buddy, your blog's design is simple and clean and i like it. Your blog posts are superb. Please keep them coming. Greets!!!

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Jess said...

Hi, nice blog. I noticed on most of your podiatrist shoe recommendations that none of the shoes are really recommended for peripheral neuropathy and lower back pain. I have peripheral neuropathy due to Celiac disease. What kind of shoes (particularly sandals) would you recommend for peripheral neuropathy and back pain? Or do I need to just go to a podiatrist and get orthotics?

Jess said...

Hi, nice blog. I noticed on most of your podiatrist shoe recommendations that none of the shoes are really recommended for peripheral neuropathy and lower back pain. I have peripheral neuropathy due to Celiac disease. What kind of shoes (particularly sandals) would you recommend for peripheral neuropathy and back pain? Or do I need to just go to a podiatrist and get orthotics?

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Jess,
I have to be very careful about what I recommend for peripheral neuropathy patients because the severity of the disease can range from mild to severe. The Rx Crocs are approved by the American Podiatric Association for diabetics, which means they should be appropriate for most patients with neuropathy. The NB 928 are appropriate for most patients with diabetes and peripheral neuropathy. I would consult your podiatrist for what shoes are appropriate for you.
Hope all is well and thank you for reading!
Cathy
:)

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Anushka Sharma said...

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Anonymous said...

Not sure what you are smoking when you recommend Crocs -- the soles are flimsy.

According to your recommendation, I bought a pair Crocs Relief. They are so flexible that I might as well wear flip-flops. I have to send them back.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Anonymous,
Sorry that the Rx Crocs didn't work for you. I would recommend you follow up with your local podiatrist to get recommendations better suited to your particular foot issues.
Best wishes,
:)

Love Shuz said...

Great blog. i m from Canada. i have my own Shoes Stores Toronto in Canada. we providing ladies and men's both design of shoes.

Wilfredo Hernandez said...

I didn't know that podiatrists had special shoes for broken toes. I was one of the people you mentioned in your article who thought that there was no real treatment for broken toes. I also didn't know that certain medical conditions are made worse with icing your feet. Thanks for the tips, if I ever get a broken toe I will look for a special shoe or boot. http://thefootandanklecarecenter.com/

Jordan said...

Great information here. I've heard the common myth that there's nothing that can be done about a broken toe, and your article DEFINITELY shows how untrue that is! It's very important to treat any toe you think is broken right in order to make sure it heals properly.

James Hannon said...

Would love to see a post on recommended cross trainers (or tennis shoes something with lateral stability) for those who require moderate to severe motion control. Both me and my wife struggle to find anything that isn't a running shoe.

Thanks!

MsWill2u said...

HELP Please.
-Plantar Fasciotomy Surgery (L&R) 2006
-Radiofrequency Endovenous Ablation (L&R Leg) 2007
--2nd Meterarsal Foot Fracture Surgery
(Plate & Screws) 3 June 2015
*Just weening off the boot.
-Severe Metatarsalgia (L&R)
I am not even close to being over weight.
Had to give up running and now even casual walking, foot pad pain is SEVERE! *burning and pain (L&R)
I need shoe recommendation that supports metatarsal plate, plantar fasciiti and especially Metatarsalgia.

A big challenge, please help.

Jordan said...

Some very important points here! I know of many people who don't go to the doctor's when their toe is broken because of these myths. It's so important to see a doctor and do what you can for your feet to prevent long-lasting problems!

Kirra said...

I just wanted to let you know how helpful your site has been. I broke my fifth metatarsal in the middle of June. When I was given permission to start wearing normal shoes, I got a pair of Brooks running shoes http://www.brooksrunning.com/en_us/adrenaline-gts-15-womens-running-shoes/120174.html?cgid=womens-runningshoes-cushionme&srule=best-matches&dwvar_120174_color=179&dwvar_120174_width=B#start=1 the best option the store I went to had in my size. The sole flexes a bit in the toe but otherwise is very firm. A week later, I bought a pair of the Crocs you recommend. Soon I plan to buy a pair of the Dansko professional clogs that you suggest. I tried on a pair today and liked them very much. They're very comfortable, but I was surprised at how low the back was, especially now that I'm used to these running shoes. I am sure that my shoes have at least half the blame for my break, so I'm planning to throw out the majority of my cheap shoes and start investing in quality shoes! I look forward to coming back to your site every time I'm ready to look for something new.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Jordan,
Thanks for reading and commenting!
Cathy
:)

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Kirra,
I'm so glad you are getting better! Thank you so much for reading the blog and for your kind words!!
Best wishes!
Cathy
:)

Pauline Patrick said...

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Sherry Robertson said...

Glad I came across this! I broke the second toe on a drawer that was not closed properly. It hurt so bad I started shaking and the toe decided to make a distinct left turn right at the base. Just as you stated, my doctor said nothing could be done and to tape it. I have to be up and around quite a bit and I just could not do it. I have a cam walker from when I had ankle surgery. I told my husband, it may be overkill for a broken toe, but I am going to use it! Guess it isn't overkill after all. Thanks for this information!

Anonymous said...

Thank you for that information Dr McArthy.My son broke his toe playing football or when he hit it on a metal stick slightly exposed off the ground. Both times hurt terribly. Took him for x rays but we were told they were inconclusive. No swelling or bruise just pain. 6 months later he still hurts feels pain at times playing football. Few days ago did x rays and CT scan. Yes it was broken. Would a moon boot heal it or is surgery unavoidable? The fragment of bone is still attached but bone is not straight and smooth. I am afraid he won't be able to play football (soccer) again. He is training to be a pro. Looking forward to advise. Thanks

Anonymous said...

This is a very explanatory article. Simple yet precise! I am on my 4th week of nursing a broken " ring" toe of the left foot. I never dreamed how debilitating a broken toe could be!!! Today is my "anniversary " day of 4 weeks ago :(
I can walk better today than yesterday.My advice is to anyone looking for answers on broken toes, do what this article says and be patient! LOL