Finger or Toe Injury

Pediatric HouseCalls Online

DEFINITION

• Injuries to fingers or toes.

Types of Finger / Toe Injuries

• Cuts, scrapes (skinned knuckles) and bruises:  the most common injuries.
• Jammed finger or toe:  The end of a straightened finger or thumb receives a blow (usually from a ball). The energy is absorbed by the joints' surfaces and the injury occurs there. For jammed fingers, always check carefully that the end of the finger can be fully straightened.
• Crushed or smashed fingertip or toe: (e.g., from car door or screen door). Usually the end of the finger receives a few cuts or a blood blister. Occasionally the nail is damaged, but fractures are unusual.
• Fingernail injury:  If the nailbed is cut, it needs sutures to prevent a permanently deformed fingernail.  This is less important for toenails.
• Blood clot under the nail:  Usually caused by a crush injury from a door or a heavy object falling on the finger while it is on a firm surface. Many are only mildly painful. Some are severely painful and throbbing.  These need the pressure released to prevent loss of the fingernail and to relieve the pain.
• Fractures or dislocations.

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You think your child has a serious injury.
• Bleeding won't stop after 10 minutes of direct pressure.
• Looks like a broken bone or dislocated joint.
• Skin is split open or gaping and may need stitches.
• Large swelling is present.
• Blood that's present under a nail.
• Fingernail is torn
• Dirt or grime in wound is not removed after 15 minutes of scrubbing
• Finger joint can't be opened (straightened) and closed (bent) completely.
• Toe injury that causes bad limp or can't wear shoes.
• Severe pain.
• Age under 1 year old.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen.

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Pain not improving after 3 days 
• Not using the finger or toe normally after 1 week

Parent Care at Home If

• Minor finger or toe injury and you don't think your child needs to be seen.

HOME CARE ADVICE FOR MINOR FINGER/TOE INJURIES

1. Bruised/Swollen Finger or Toe:
   • Soak in cold water for 20 minutes.
   • Give acetaminophen (e.g. Tylenol) or ibuprofen as necessary for pain relief.
2. Superficial Cuts:
   • Apply direct pressure for 10 minutes with a sterile gauze to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes.
   •  For any dirt in the wound, scrub gently.
   • Cover any cuts with an antibiotic ointment and Band-Aid. Change daily.
3. Jammed Finger or Toe:
   • Caution: be certain range of motion is normal (can bend and straighten each finger).If movement is limited, must check for a fracture. 
   • Soak the hand or foot in cold water for 20 minutes.
   • Give acetaminophen (e.g. Tylenol) or ibuprofen as necessary for pain relief.
   • If the pain is more than mild, protect it by "buddy-taping" it to the next finger.
4. Smashed or Crushed Fingertip or Toe:
   • Wash the finger (or toe) with soap and water for 5 minutes.
   • Trim any small pieces of torn skin with a fine scissors cleaned with rubbing alcohol.
   • Cover any cuts with an antibiotic ointment and Band-Aid.  Change daily.
   • Give acetaminophen (e.g. Tylenol) or ibuprofen as necessary for pain relief.
5. Torn Nail (from catching it on something):
   • For a cracked nail without rough edges, leave it alone.
   • For a large flap of nail that's almost torn through, use a sterile scissors to cut it off along the line of the tear (Reason: Pieces of nail taped in place will catch on objects).
   • Soak the finger or toe for 20 minutes in cold water for pain relief.
   • Apply an antibiotic ointment and cover with a Band-Aid.  Change daily.
   • After about 7 days, the nailbed should be covered by new skin and no longer hurt.   A new nail will grow in over 6 to 8 weeks.
6. Pain Medicine:  Give acetaminophen (e.g. Tylenol) or ibuprofen as needed for pain relief.

7. Shoes:  If regular shoes cause too much pain, wear open-toe sandals with a firm sole until the injury heals.

8. Call Your Doctor If:
   • Pain becomes severe
   • Pain not improving after 3 days.
   • Not using the finger or toe normally after 1 week.
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.