View Full Version : Broken or dislocated toe
Scotter260
03-25-13, 17:44
Stubbed my pinky toe bad on the bathroom doorframe last night. Toe now points NE instead of N, is swollen, slightly bruised and painful. Tried to get into clinic today but local podunk doesn't x-ray and Urgent Care in larger town was 15 people deep.
Are there any hard fast ways to differentiate between a break and dislocation? Any way to isolate which joint if it is dislocated? If I'm outside the 6 hour window for resetting am I better off waiting or should I just try to do it. Should I take something to get the swelling down before trying? I haven't taken anything at this point figuring it isn't going to help much anyway since it's obviously deformed.
I swear I won't hold anyone to any advice they give and if you need a waiver signed I'll sign it.
Just ice it and get to the doctor when you can. Broke my hand in a fight in middle school and avoided the doctor for a week because I didn't want my parents to know. I just iced it when I could and kept from using it as much as possible and it didn't really get any worse. But I would get in as soon as I could if I were you, because other things can arise from breaks without being fixed (blood clot) although extremely unlikely, why risk it.
I have to ask, picture?
Tape it to the toe next to it. Stiff-soled shoes may make it easier to walk. That's likely all they'd do at urgent care.
Ready.Fire.Aim
03-25-13, 19:20
If you can afford to go to a medical professional, why wouldn't you? You can always refuse treatment.
Or you can be hardheaded like me. Broke my toe on a rock tubing river rapids a dozen years ago. I was showing at the time, my 12 year old, how " fun" it was. Then the 11 year old wanted to go, I hit the same toe on a rock. Hurt like heck and it turned black. I wouldn't go to the Dr. because I was on vacation and it was just a toe. I just iced it.
Last year I flipped a 4 wheeler in the mountains going way to fast- on vacation. I was like Rocky the Flying Squirrel for a few seconds. Screwed up a shoulder and ribs. I just iced it. Not going to the Dr was a decision I regretted. I have spent much $$$ trying to to recover joint mobility.
Tape it to the toe next to it. Stiff-soled shoes may make it easier to walk. That's likely all they'd do at urgent care.
+1. Buddy tape that bad boy to its neighbor and call it a day. It should start to feel much better in 2-4 weeks. That is the treatment for a broken little piggy.
shadowrider
03-26-13, 01:39
Sounds like you might get by with tape. I did the same thing only I caught the door edge with mine. It was pointing straight frigging east, I kid you not. The doc looked at it and said WOW! Is this broke or were you born this way? Smart a$$....:rolleyes:
He did x-ray it and told me he was going to have to set it back in place because I broke the joint all to hell. He numbed it up with a needle and that hurt far more than the break. After he was done it was just tape for a few weeks.
Sounds like you might get by with tape. I did the same thing only I caught the door edge with mine. It was pointing straight frigging east, I kid you not. The doc looked at it and said WOW! Is this broke or were you born this way? Smart a$$....:rolleyes:
He did x-ray it and told me he was going to have to set it back in place because I broke the joint all to hell. He numbed it up with a needle and that hurt far more than the break. After he was done it was just tape for a few weeks.
Only pussies get it numbed before reducing the dislocation. Real men do it the Martin Riggs way, "We go on three, 1…2…"
16065
I'm not sure that the digital block for the reduction of a 5th toe isn't more painful than the actual reduction. It isn't like precision is paramount in the reduction. One would just like to have that little toe pointing in the same general direction as the rest of them.
A little Versed, a little Fentanyl, 1..2..3..grit your teeth for a moment...done.
Gutshot John
03-27-13, 15:09
We go on three.
Then count to one and do it ;)
Nobody here can examine your toe and i would rather go thru the pain and healing process once than need to have it re-broken and set by a doctor again later. Also consider seeing an ortho guy rather than urgent care it could save seeing 2 docs if the urgent care refers you elsewhere
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Hot Holster
03-27-13, 16:31
Tape it to the toe next to it. Stiff-soled shoes may make it easier to walk. That's likely all they'd do at urgent care.
+1, unless it broke a bone in the foot, the most they will do is tape it.
Just make sure the tape is secure. My pinkey on my left foot is straight but twisted 1/4 turn. It works and is there, causes no pain but woman with a foot fetish linda get put off.
A little Versed, a little Fentanyl, 1..2..3..grit your teeth for a moment...done.
If you think that I'm going to spend an hour completing procedural sedation paperwork (thank you Joint Commission) and jumping through the hoops for a pinky toe, then you are out of your f-ing mind. Real men take the pain. It puts hair on the chest.
texasgunhand
03-27-13, 23:06
If it doesnt turn black and you can move it,, Just rub some dirt on it and walk it off.
Tape it to the next one,and take it easy..Thats about all you can do but spend money and get pain pills. But if it turns black and you cant move it,go to the DR.
If you think that I'm going to spend an hour completing procedural sedation paperwork (thank you Joint Commission) and jumping through the hoops for a pinky toe, then you are out of your f-ing mind. Real men take the pain. It puts hair on the chest.
We're also Joint Commision, but the paperwork for moderate sedation is quite simple around here.
Some posters here are overthinking the issue. We're talking about the 5th toe. Functional disability from a fracture or fracture/dislocation is negligible. Diagnosis and treatment of such an injury isn't something that warrants a lot of time or expense.
We're also Joint Commision, but the paperwork for moderate sedation is quite simple around here.
Some posters here are overthinking the issue. We're talking about the 5th toe here. Functional disability from a fracture or fracture/dislocation is negligible. Diagnosis and treatment of such an injury isn't something that warrants a lot of time or expense.
Those days are over at every hospital where I work. Moderate sedation (ketamine or benzo + opiate) means at least 5 pages of assessment, consents, and recovery paperwork. It also ties me up for 15-20 minutes, as well as a nurse and a respiratory therapist for about 30 minutes. Deep sedation (propofol or etomidate) is much worse because it requires 2 physicians - 1 for the sedation and another for the procedure. Thank you Michael Jackson. Actually, I doubt that the King of Pop had anything to do with it, but that was when hospitals started really cracking down.
Reducing a toe or finger dislocation is stupid easy. Simply pull. It will hurt for a second or two and then feel much better. Subjecting someone to the risks of sedation (granted very small) and the costs (about $1000) for such a simple procedure would raise some eyebrows in my neck of he woods.
I've never even applied for deep sedation (propofol) privileges. I just have them call an anesthetist if that's required. Moderate sedation (narcotic+benzodiazapine) is pretty routine and poses little inconvenience to me from a paperwork standpoint the way we have it set up. Most of my use of propofol sedation is done in surgery or endoscopy, however. I occasionally use moderate sedation in the ER or ICU, but generally speaking, if a surgeon is required for something in the ER or ICU then we're usually talking about a procedural magnitude that warrants propofol.
Another trick is to simply put an ice pack on the affected finger or toe for about 30 min. That will provide some local anesthesia before applying longitudinal traction. If it is a little toe, all you need to do is buddy tape it to the 4th toe. There is no real need for x-rays if you are healthy and get reasonable anatomic alignment. Personally, I like to get all wide-eyed and crazy like Martin Riggs right before I pull on it - I think it make the patients feel more at ease. When it pops into place, I celebrate with a loud, Rick Flair "WOOOO!"
Fingers 2-5 get a little more tricky. This is especially true if there is an intra-articular fracture that prevents full extension or tendon disruption. Thus, I do recommend an x-ray and ortho referral for all finger dislocations that are persistently unstable after reduction or that do not achieve full range of motion after 1-2 days of immobilization.
When it comes to the thumb - all bets are off. See a doctor if you have any deformity or loss of movement. After all, the ability to perform thumb opposition is vital to most people's career (it basically distinguishes me from a panda bear). There are plenty of ligamentous injuries such as a Game Keepers Thumb that require operative repair. Then, there are fractures to the thumb metacarpal (Bennett's and Rolando's) that may require pinning to get a good functional outcome. In addition, thumb pain may also be associated with scaphoid injuries that are at risk for AVN/non-union if you do not adequately immobilize it. Bottom line, don't be cheap with your thumb or your hand - it will cost you in the long run.
Finger fractures are completely different than toes in terms of functionality goals.
Scotter260
03-29-13, 00:39
Well, later that evening I started working on it pulling it out and in, nothing really vigorous but it wasn't doing much. To my surprise the swelling had gone down in the morning although I was still hobbling around and I could see it was still pushing the sock out a bit.
I decided I still had to work out so I stuffed my foot in my shoes and tightened them up pretty well. Still hobbling but not nearly as badly, I had to walk to the bathroom and when I planted that foot I thought I felt it catch with some slight pain similar to what I'd been feeling every time I stepped. Well, suddenly on my walk back to our workout area, I noticed no where near the pain I'd been feeling while walking. I checked it and it appeared to be slightly straighter although still not quite right. I didn't care, it didn't feel as "bound up" as it had before and the pain was very tolerable - I wasn't pleased with the pain up to that point but could stand it, I just didn't like thinking it was all out of whack - God knows how important the little toe is :rolleyes:.
Now it's getting exponentially better each day although there is bruising from that toe behind all the other toes that stops at the space between the big and index toe and the tip still seems like it's "off" a bit but I'm ambulating at a tolerable level.
Thanks for the advice guys, sorry for being such a puss.
As an athletic trainer I'll tell you what I have told countless others... Do you know what you do for a broken toe? - nothing....
Make sure it is pointing in the right direction (pull it straight.... Firmly, and make sure it "looks" ok). Don't bother buddy taping, you'll just get a blister. Wear supportive shoes, preferably with a stiff shank. Your toes act as a paddle, and unlike fingers the buddy tape is unnecessary.
Fractures will heal in 6-8 weeks. Dislocations sooner, but will be more sore longer and possibly reinjured easier.
Ice
NSAIDS (Aleve or Advil as directed and necessary)
Good shoes or boots with a shank
That's it.
I've gotten college athletes through seasons doing nothing more than that.
My motto was "fix fingers fast. Fu(# toes..."
Good luck!
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Personally, I like to get all wide-eyed and crazy like Martin Riggs right before I pull on it - I think it make the patients feel more at ease. When it pops into place, I celebrate with a loud, Rick Flair "WOOOO!"
I'm coming to you if I mess up a finger or toe, I like your style!!
Red
ouch, i have a feeling my big toe is dislocated/not sitting right and it doesnt hurt, but i cringe at the thought of my pinky toe doing the same thing.
ouch, i have a feeling my big toe is dislocated/not sitting right and it doesnt hurt, but i cringe at the thought of my pinky toe doing the same thing.
"dislocated" and "doesn't hurt" are pretty much mutually exclusive.
ouch, i have a feeling my big toe is dislocated/not sitting right and it doesnt hurt, but i cringe at the thought of my pinky toe doing the same thing.
What??
And they rip GD.
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