Breaking a toe is easier than you think. While you rush around the wrong corner, the wrong open-toe shoe can create the right circumstances for a big toe fracture. Broken big toe symptoms and treatment are explained so that you understand how something as silly as a big toe fracture can cause lower back pain in the future. Make sure your fractured big toe recovery is smooth to get back to what you love doing, limp-free.
The Anatomy of your Big Toe
Your foot is an amazingly complex mechanical design. It has 28 bones that articulate with one another to form 33 joints on each side! 19 different muscles attach and form 100 cross bridges with ligaments in your foot. Many tiny peripheral nerves send information down to allow muscle contraction to propel you forward while walking or maintain your balance when landing from a jump. These nerve endings also receive information from the surface you are navigating, the pressure of those new shoes on your heel and the temperature when you wet your toes in icy water.
Anatomists divide the foot into the hind, middle and forefoot. Your forefoot has 21 bones. These are the 5 metatarsal bones, that connect the midfoot (arch) with your toes. You then also have 14 phalanges, the tiny bones in your toes, 2 in the big toe and 3 in your other 4 toes.
What does my big toe do?
The first metatarsal bone, which articulates with your big toe, is important for forward movement, while the other 4 provide stability. Your 1st metatarsophalangeal joint (big toe attachment to foot) can move up into extension (dorsiflexion) and down into flexion (plantarflexion). Ideally, you want a strong and mobile big toe that has 70 degrees of movement available in both directions, especially if you run. You should also be able to open and flare your toes away from one another into abduction.
Hallux rigidus, where big toe extension is less than 20 degrees can contribute to plantar fasciitis, shin splints, gluteal bursitis and lower back pain, all because of compensatory movement that goes unchecked.
I have a broken big toe, how did it happen?
Bone is elastic to a certain degree, which means that the tissue allows for some shape change, but much less than a ligament or muscle. A growing child’s bones would be more elastic than an adult’s. When the load applied exceeds the elastic capacity, tissue failure occurs. The angle, movement direction and force determine if you end up with a big toe fracture.
How severe is my big toe fracture?
A broken big toe is sore. It is a frustrating injury to have when you need to navigate your world with crutches. We aim to facilitate the physiological healing process and avoid complications. Complications from a fractured big toe can be as simple as stiffness of the joint or as severe as a blood clot or complex regional pain syndrome.
Comorbidities like being a smoker, having diabetes or cardiovascular conditions influence circulation and therefore healing speed. If you have had previous foot injuries or complicated surgeries you are at risk of developing complex regional pain syndrome. Complete bed rest and oral contraceptives can increase your risk of developing blood clots.
Your broken big toe and your circumstances are unique. Our physiotherapists can screen and advise you so that we can customise your care.
Diagnosis of broken big toe
Physiotherapy diagnosis of big toe fracture
Our physiotherapists can make a clinical diagnosis of a big toe fracture in the rooms. We understand the physiological healing stages bone goes through. The rest of you don’t have to sit around and wait for your big toe to heal, we can give you alternative movement and exercise ideas that you can pursue throughout your fractured big toe recovery. By understanding your recovery you will be able to make responsible decisions. This enables you to avoid compensatory pathologies, like developing sciatica because you were limping too long.
History
Your mechanism of injury will be the biggest clue as to whether you sustained a big toe fracture. Direct trauma, like another player’s boot, hockey stick or dropping a weight or other heavy object onto your foot can cause a big toe fracture. Repetitive overuse, like changing training load and introducing new exercises can cause big toe fractures or stress fractures.
X-rays
X-rays show the integrity and alignment of foot bones. We can see a phalangeal fracture on a basic dorsal plantar and lateral view X-ray image. Your physiotherapist can refer you to get X-rays taken if necessary.
MRI
An MRI scan can visualise all of the structures in your foot, including muscles, tendons and ligaments. This is unnecessary and very expensive for a big toe fracture. If your physiotherapist suspects anything more than just a broken big toe, you will be referred to the right specialist.
Why is my big toe pain not going away?
A big toe fracture that is not immobilised and rested will not heal. Squeezing and forcing your foot into running shoes, training through the pain and ignoring your symptoms will not make the pain go away.
If you are wrongly diagnosed with gout you are not getting the correct treatment and this may cause delayed or non-union of your big toe fracture.
Gout is a type of arthritis that can affect people of any age, at any time in their life. It usually attacks a single joint and commonly the big toe. It is characterised by sudden, severe pain, swelling, increased temperature and redness. This makes weight-bearing and walking very painful. It is caused by urate crystal build-up inside a joint. Your body forms these crystals as a by-product when breaking down purine. Purine is found naturally in our bodies and the food we consume, especially red meat, seafood, red wine and sweetened juice. It used to be described as the “disease of kings” because of the diet high in meat enjoyed by the royal household.
Problems we see when patients come to us with big toe fractures
Waiting too long
The longer you wait, the bigger your chances of compensation strategies causing other pathology. Yes, limping after you broke your big toe is normal, but do that for 3 months and you are guaranteed hip or back pain because of the way you move.
Starting strenuous activities too fast
Your big toe may feel better with daily walking or driving after 8 weeks, but hold on before you lace up those tekkies and try to catch up on lost steps. If you haven’t put in the work to restore your range of motion you can end up with other injuries, like plantar fasciitis. Our goal is to keep you as active as possible but safe.
Crutches
Crutches are only needed during the first 2 weeks or if you have long distances to walk at work. The crutches take the load off of the fractured big toe. When your pain settles you will be able to walk with only the brace or strapping. This ensures your knee, hip and back moving as normally as possible.
Misconceptions about treatment
The healing of bone is sore. Pain doesn’t mean more damage. We can look at other signs like swelling, temperature and movement during your recovery as your body does the amazing job of healing bone.
Broken big toe physiotherapy treatment
Our physiotherapists can distinguish between bone, including joint, ligament, tendon, muscle and nerve injuries. We understand how these structures have to work in harmony to ensure fluid, balanced and precise movement. Movement patterns and how joints influence one another are a language we understand like musicians understand notes and dancers’ choreography.
Phases of rehabilitation for big toe fracture treatment
1st Phase of broken big toe treatment: Protect and relative rest (weeks 0 – 2)
Once the correct diagnosis is made we can explain your recovery journey and goals. Your physio will teach you the basics of protecting your broken big toe, what to do, how to strap and what other movements or alternate exercises you can do. We can aid pain relief with some electrotherapy modalities.
2nd Phase of broken big toe treatment: Active range of motion (weeks 3 – 4)
Now that your pain has settled we can incorporate active ankle, foot and toe movements into your exercises. You should be able to move your big toe up, down and sideways to progress to the next phase of you big toe rehabilitation.
3rd Phase of broken big toe treatment: Resisted training (weeks 5 – 6)
Now the fun starts when we can add resistance to the movement you have gained. Balance drills and therabands will be part of your routine now. Once you can do a set of 15 calf raises you can progress to the next phase of your big toe fracture treatment.
4th Phase of broken big toe treatment: Gait & conditioning (weeks 7 – 8)
During this phase of your fractured big toe recovery you can expect the focus to fall on precision and push-offs during the gait cycle, some lunges and explosive exercises like skipping.
5th Phase of broken big toe treatment: Return to activity (weeks 8 – 12)
To make sure you’re safe to turn to jogging or other exercises that require full toe movement we incorporate your unique needs in your final rehabilitation. Burpees, sun salutations or pointe, we will help you get back to what you love doing.
Fractured big toe recovery time
Bone fractures take 6-8 weeks to heal. Getting back to wearing high heels or running may take another 4 weeks where you are actively working on gaining strength, endurance and mobility.
We aim to explain the recovery and goals during your first consultation and give you pain relief strategies. Your physiotherapist can teach you to buddy strap your broken big toe. The real work starts between 3 – 8 weeks when we can assist you with rehabilitation exercises to enable you to return to your hobbies, exercise and everyday life. From 4 – 8 weeks after your big toe fracture we will see you every week to progress your rehabilitation.
Other forms of big toe fracture treatment
- Your doctor (GP) will most probably prescribe oral analgesic medication to aid pain in pain relief.
- An orthotist can provide the moon boot if your foot doesn’t need to be cast in plaster of paris.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport, that is after you can move your toe through full range of motion.
Is surgery a treatment option for my fractured big toe?
Surgical intervention is rarely needed for big toe fractures. Internal fixation can be considered by your orthopaedic surgeon in cases of dislocation, displacement and multiple fractures that include the metatarsal bones.
The recovery from surgery includes non-weight-bearing walking, that is with crutches, without your foot touching the ground.
It is essential to get the mobility of your big toe back after any period of immobilisation to get you back to your training and running. The rehabilitation continues even after you are allowed to walk normally again.
What else could it be?
- Gout
The build-up of urate crystals causes intense pain, swelling and limitation of movement. This happens spontaneously, without a direct injury, usually after over-indulgent festivities.
- Dislocation
Ligament sprain or rupture can cause a dislocation without a fracture.
- First metatarsal fracture
The bone in the foot sustained the fracture and not the toe. You will experience similar symptoms of pain, swelling and inability to walk.
Nerve entrapment in your lower back can cause toe pain with accompanying pins & needles, numbness or weakness.
Broken big toe also known as:
- Big toe fracture
- Broken toe
- Fractured big toe
