Toe Injury

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DEFINITION

• Injury the skin or nail of the toe.
• Injury to a bone, muscle, joint or ligament of the toe.

Types of Injuries

• Abrasions or Scrapes: An area of superficial skin that has been scraped off. Commonly occurs on the knuckles.
• Bruises: Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.
• Cuts and Scratches: Superficial cuts (scratches) only extend partially through the skin and rarely become infected.  Deep cuts (lacerations) go through the skin (dermis).
• Fractures (broken bones)
• Dislocations (bone out of joint)
• Jammed or Stubbed Toe: The end of a straightened toe receives a blow (usually from kicking something). The ligaments and tendons of the toe are stretched and torn.
• Smashed or Crushed Toe: This injury most often results from a heavy object falling on the toe. Usually the end of the toe receives a few cuts, a blood blister or a bruise. Sometimes the nail is damaged. A fracture of the bones inside the toe can occasionally occur.
• Subungual Hematoma (blood under toenail): This medical term is applied when a blood clot forms under the toenail. It is caused by a crush injury to the tip of the toe. Some are only mildly painful  and blood is typically under less than 50% of nailbed. Others can be severely painful and throbbing, and these may need the pressure released to relieve pain. The pressure can be released by putting a small hole through the nail.  With larger subungual hematomas, the toenail will usually fall off. A new nail will grow back in 6 to 12 weeks.
• Torn Nail: From catching it on something.

When are Stitches Needed?

• Any cut that is split open or gaping probably needs sutures (stitches). Cuts longer than 1/2 inch usually need sutures.
• A physician should evaluate any open wound that may need sutures regardless of the time that has passed since the initial injury.

See More Appropriate Topic (instead of this one) If

• ANIMAL BITE to toe
• BURN of toe
• SPLINTER OR SLIVER in toe
• PUNCTURE WOUND to toe

FIRST AID Advice

FIRST AID Advice for Bleeding:  Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object:If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).

FIRST AID Advice for Shock:Lie down with feet elevated.

FIRST AID Advice for a Sprain of the Toe:

• Remove any rings or jewelry from the injured toe.
• Tape the injured toe to the toe next to it (this is called a buddy splint).
• Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.

FIRST AID Advice for Suspected Fracture or Dislocation of the Toe:

• Remove any rings or jewelry from the injured toe.
• Tape the injured toe to the toe next to it (this is called a buddy splint).
• Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes.

FIRST AID Advice for Transport of an Amputated Toe:

• Briefly rinse amputated part with water (to remove any dirt).
• Place amputated part in plastic bag (to protect and keep clean).
• Place plastic bag containing part in a container of ice (to keep cool and preserve tissue).

WHEN TO CALL YOUR

Call 911 Now (you may need an ambulance) If

• Major bleeding (actively bleeding or spurting) that can't be stopped
• Toe has been partially or completely amputated
• NOTE: For bleeding, see First Aid.

Call Your Doctor Now (night or day) If

• You think you have a serious injury

• Injury looks like a dislocated joint (crooked or deformed)
• Bleeding that hasn't stopped after 10 minutes of direct pressure
• Cut or scrape is very deep (e.g. can see bone or tendons)
• Skin is split open or gaping and may need stitches
• Blood present under the nail is causing severe pain
• Toenail is torn from a crush injury or cut
• Dirt or grime in the wound is not removed after 15 minutes of scrubbing
• Toenail is completely torn off
• Base of toenail has popped out from under skin fold
• Cut or scrape looks infected (redness, red streak or pus)

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

• You think you need to be seen
• Cut or scrape and its been more than 10 years since last tetanus booster (5 years for dirty cuts and scrapes)
• Diabetic with any toe injury

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Injury interferes with work or school
• Injury and pain have not improved after 3 days
• Injury is still painful and swollen after 2 weeks

Self Care at Home If

• Minor toe injury and you don't think you need to be seen

HOME CARE ADVICE FOR MINOR INJURIES OF TOE

1. Treatment of Cuts, Scratches and Scrapes (abrasions):
   • Apply direct pressure for 10 minutes to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes.
   • Scrub out any dirt gently with a washcloth.
   • Cut off any pieces of dead loose skin using a fine scissors (cleaned with rubbing alcohol).
   • Apply an antibiotic ointment, covered by a Band-Aid or dressing.  Change daily.
2. Treatment of Bruised Toe: Soak the toe in cold water for 20 minutes.
3. Treatment of Jammed Toe:
   • Caution - Be certain that there is no deformity (the toe lines up normally with the other toes).
   • Soak the toe in cold water for 20 minutes.
   • If the pain is more than mild, protect it by "buddy-taping" it to the next toe.
4. Treatment of Smashed or Crushed Toe:
   • Apply an ice bag to the area for 20 minutes.
   • Wash the toe with soap and water for 5 minutes.
   • Trim any small pieces of torn dead skin with a scissors cleaned with rubbing alcohol.
   • Cover any cuts with an antibiotic ointment and Band-Aid. Change daily.
5. Treatment of Subungual Hematoma (blood present under toenail): Apply an ice bag to the area for 20 minutes.
6. 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 will catch on objects and tear further)
   • Apply an antibiotic ointment and cover with a Band-Aid. Change daily.
   • After about 7 days, the nail bed should be covered by new skin and no longer hurt. It takes about 6-12 weeks for a toenail to grow back completely.
7. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
8. Call Your Doctor If:
   • Cut or scrape looks infected (redness, red streak or pus)
   • Pain becomes severe
   • Pain does not improve after 3 days
   • Pain or swelling lasts more than 2 weeks
   • You become worse

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