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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:

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)

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


Monday, June 15, 2015

Podiatrist Recommended - Steve Madden's Brooklyn: A Comfortable Wedge Sandal for Summer

Steve Madden Brooklyn
A comfortable low wedge for summer

This sandal is a great option for anyone looking for a comfortable sandal for light summer activities. Although it may not be appropriate for being on your feet all day for heavy activities (like walking around at a music festival on uneven surfaces or going to Walk Disney World for the whole day), I would recommend it to most patients for light activities. The wedge is thick, rigid and has minimal flexibility, which allows for more comfort. The topcover material is stretchy, which is great for anyone with bunions as it can hide the bunion with minimal pressure on the bunion. This shoe also has the forefoot, midfoot and rearfoot strapping that is required for a shoe to be comfortable and make my list for a 'podiatrist approved' shoe. I also like that the material on the insole is soft against the bottom of your feet, which is helpful to anyone who has calluses or sensitive feet. This shoe will not accommodate an orthotic, so if it is crucial that you wear your orthotics, this may not be a good choice for you. 

This shoe is recommended for patients with:
*Mild to Moderate Bunions
*Tailor's Bunions
*Mild to Moderate Hallux Limitus (limited range of motion through the 1st toe joint)
*Hallux Rigidus (no range of motion through the 1st toe joint) or if your 1st toe joint has been surgically fused at the standard 15 degrees of dorsiflexion. 
*Mild Osteoarthritis
*Mild Rheumatoid 
*Morton's Neuroma
*Mild Capsulitis
*Mild Plantar Plate issues
*Mild Sesmoiditis
*Mild Plantar Fasciitis (heel pain)
*A 'bump' (exostosis) on the top of the midfoot

This shoe is not recommended for patients with: 
*Severe Over-Pronation
*Ligament Laxity / Hypermobility
*A history of chronically rolling your ankles
*Achilles Tendonitis
*Posterior Tibial or Peroneal Tendonitis
*Recovering from a Recent Lisfranc's Injury 
*History of Foot Ulcerations
*Peripheral Neuropathy (nerve damage)
*Peripheral Arterial Disease (poor circulation)
*Charcot Foot
*Geriatric patients with a history of imbalance or falling

I hope this has been helpful. For more information, please refer to my blog articles:

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

Shoe recommendations for patients recovering from Lisfranc Injuries. 

If you are experiencing foot or ankle pain, I would highly recommend that you make an appointment with your local podiatrist. Do not jump into foot surgery! Most foot and ankle pain can be resolved with better shoes, inserts and changing some simple habits. If you are considering foot surgery, I would recommend that you exhaust conservative treatment before you decide to do surgery. For more information, check out my article:
Ten things you need to think about before having foot surgery.

Have a wonderful day!

Dr. Cathleen A. McCarthy


Please share my blog with any 'limpers' in your life who you may thing this information will help. Thank you so much for reading the blog - and sharing the information!