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The response to the question below was authored by Marc Mitnick DPM

Pain when bending the right toe forwards but not backwards

by Dar
(Uk)

About 3 weeks ago I dropped a 3kg stone on my right toe. It swelled up and was obviously bruised as it went blue. However, I don't believe I broke anything as the swelling itself disappeared after a week or so. I am able to walk but I cannot bend it forwards towards the palm of my feet. I believe it could either be a small fracture or a tendon problem since I am now having problem putting weight on it. Is it worth getting an xray and going to the hospital? I'll be doing a 250 km trek in three weeks so discomfort would certainly hinder my activities. What should I do/what may be the problem?

RESPONSE

Hi Dar,

I think you answered your own question when you stated that you have a long hike coming up in three weeks. If you have that has lasted three weeks and if over that three week period the pain has not substantially reduced (never mind the black and blue or the swelling) then there is a fair chance the toe will still hurt you to some extent three weeks from now.
It would seem to me that if the toe only hurts when you bend it down then more than likely you injured what is known as the extensor hallucis tendon which is the tendon on top of the toe that bends the toe upward.
When you force the toe downward you are basically stretching that tendon and if it is injured that will cause

pain. Most people will not feel any pain when they bend the toe upwards.
When walking you do not really need the big toe to bend downwards. In the gait cycle the toe should be able to be upwards at what is known as toe-off which is the position of the foot just before it leaves the ground and then swings forward as you walk.
At this point I am guessing you do not have much pain when walking. The problem as I see it is that in a long hike the tendon may become more inflamed than it already is and it may begin to hurt even though the toe never actually bends downward.
The other potential problem is the fact that you may have a fracture of the toe bone. You are right, it could be a small fracture, possibly a chip fracture where a piece of bone has chipped off the main bone. An injury like that could cause pain only when the toe is plantarflexed, or bent downward.
Without an x-ray it is impossible to tell if the toe is broken or not.
So, I would recommend an x-ray to see if there is a break in the bone and if the doctor decides it is only tendonitis, there is certainly treatment that will expedite the healing process and since time is of the essence, it would behoove you to speed up the healing process as quickly as possible, but first you have to have an accurate diagnosis.

Marc Mitnick DPM
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American Family Physician

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Pain when bending the right toe forwards but not backwards

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