"I thought I didn't need to see a Podiatrist for a toe break but this hasn't been getting any better!" Horace said. I looked down and couldn't help but smile. I had heard this from Penny and Rod (names have been changed to protect the . . . health information. Please google HIPPA) the week before. It's an excellent idea to consult your podiatrist whenever you injure your foot, particularly if you suspect a break. Many fractures of the toe can be treated. Depending on the severity of the break, many may respond to conservative treatment, but some might be serious enough to require surgery. Failing to get proper treatment may result in improper healing of the fracture. Deformity in the toe or foot might follow, making it more difficult to wear shoes comfortably, and reducing the function of your foot. Improper healing may also cause arthritis, or other long-term pain.
One type of break is a traumatic fracture, which results from a particular event, such as stubbing your toe on that wretched enormous dresser in the middle of the night, or possibly dropping an armful of bricks on your foot. In the case of Horace, a couple of weeks ago he had been going to get his mail (barefoot) and while returning back to the house tried walking and reading at the same time. Horace was so engrossed in the daily mail he neglected to lift his foot up on the curb at the right time and . . . WHAMMO. This type of fracture may be displaced (the broken bone has shifted from its proper position) or non-displaced (the bone is cracked, or even broken through, but it hasn't moved from where it's supposed to be).
Another type of break is a stress fracture, which occurs when repeated strain is put on a bone, resulting in small breaks that develop over time. Athletes who precipitously increase their activity (particularly runners), people with osteoporosis, and those who have abnormalities in the structure of their feet may be most susceptible to this type of fracture.
After taking x-rays of Horace's foot and diagnosing the fracture we discussed what things he should do to get better quicker. In Horace's case the break did not require surgical correction. "Horace, you need to transfer your weight to your heel as much as possible." I produced a small cushioned splint and held it up for him to see. "This splint with the padding will protect the toe." I demonstrated how it wrapped the toe bringing it securely around the adjacent uninjured one.
I also advised Horace the key to proper healing of breaks is immobilization. Finally I fit Horace for a sexy stiff-soled shoe that would keep the toes open and prevent rubbing as well as make it easier to walk on his heel.
If the bones had been dislocated or highly displaced, I would have needed to realign the bones (aka reduction) in order to get the right pieces to knit together with the other right pieces. Many times I can do this manipulation of the bones without surgery. However, especially with particularly bad breaks/dislocations, surgery may be needed to keep all the pieces of the broken bones together as they heal. Surgery often involves placing pins, screws or plates into the bone fragments to keep everything nicely aligned.
Horace was relieved to know he didn't require surgery and decided that he would limit his multitasking to walking and chewing gum.
