Big Toe Injury

by Rivi
(Albany, NY)

I work nights in a print room for NYS. We print the NYS Personal Income Tax Refund Checks. Once printed, the checks get put on a 4-way cart. Each cart holds about 64,000 checks.

Last night the big toe on my right foot, both the toe and the toe nail got run over by (1) of those carts. It throbs, hurts really bad, is black and blue and I think I may lose the nail. I don't know though if the toe is broken, but I put ice on it right away and also soaked it in a bowl of ice water.

I heard that medically, not much can be or is done if the toe is broken, so what else can I or should I do to get some relief? What do I or should I do medically?

RESPONSE

Hi Rivi,

The cardinal mistake most people make regarding broken toes is that there is nothing that can be done. This could not be further from the truth.
A broken bone is a broken bone regardless where in the body it occurs, so for that reason if a bone is broken it needs to be treated.
Assuming your toe is broken, and the only way you will know for sure is to have an x-ray, it needs to be stabilized just like a break in any other bone.
If it turns out it is a simple "crack" in the bone, then the most common treatment is to tape the big toe to the adjacent toe in an effort to immobilize it. Obviously we cannot put plaster or fiberglass casts on toes, so taping becomes the next best option. In most cases that is enough. If taped consistently, changing the taping daily, over the next six to eight weeks the bone should heal.
Sometimes if taping the toe alone still causes pain for the patient to ambulate, we can add a surgical shoe which will totally prevent the toe from bending while you walk.
Now, since a heavy cart rolled over your toe there is also the possibility that you suffered what is known as a comminuted fracture meaning the toe bone may have been crushed into smaller pieces. Again, only an x-ray will bear this out. If this turned out to be the case, your doctor would have to decide if just taping the toe would be enough to allow the toe to heal properly or would surgery need to be entertained in an effort to wire some of the broken pieces. Why would you need all this for a toe? Because if you have a broken bone that does not heal properly, it can become a constant source of pain, as an unhealed break tends to remain painful.
The next issue is the nail. The trauma you sustained may have loosened the nail and that would be indicated by bleeding underneath the nail and the nail feeling somewhat loose. The problem here, once again, is the pain factor but also the possibility of developing an infection underneath the nail as that is a common place for bacteria to harbor itself.
So although icing may make it "feel" better it is probably not doing much in getting it better.
I would suggest you see a foot specialist and have the nail and toe properly evaluated and then treated.

Marc Mitnick DPM
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