Advice is free and easily dispensed. Most of us are happy to impart what bits of wisdom we think we possess, regardless of how inaccurate, imprecise, or wholly false. Numerous examples of inaccurate medical advice can be heard, unfounded and without evidence. How about the often-heard theory that a foot or leg bone can’t be broken if you can walk on it? Wholly false since many lower extremity fractures do not produce acute, disabling pain and weight-bearing may be possible.

How about the concept that a toe fracture cannot be treated? This is heard by podiatrists on a regular basis, but again, is completely inaccurate. As is quite predictable, fractures of the toe bones are a common injury, especially since many of us stroll around the house with nary a care and no shoes. Most of us have furniture and doorways, making blunt trauma to our toes a regular occurrence. How many of us bother to put on slippers or shoes when shuffling to the bathroom in the middle of the night?

Regardless of the direction, running your foot into a doorway or a piece of furniture will tend to damage some body part, whether it’s a toe bone or the ligaments keeping the toe joint in place. Quite commonly, a joint becomes dislocated in one of these “bed-post injuries.” But without x-rays, it’s difficult to know precisely the nature and extent of the injury, was a joint dislocated or a bone broken?

Contrary to popular opinion, both of these instances benefit from some form of immobilization. Like an ankle sprain, these injuries need stabilization for pain relief and the promotion of healing. This basic approach has been utilized in the treatment of broken bones for thousands of years. That hasn’t changed, although we do it better now. We all are familiar with the application of a cast on a classmate’s broken leg. Some fractures require surgical stabilization though, with the insertion of a wire or screw crossing the fracture line, holding the pieces together.

Although many physicians recognize the importance of immobilization, those less focused on this body part may not be aware of the optimal methods. An older practice still utilized involves securing of the injured digit to a neighboring one, the ancient practice of “buddy-taping.” Certainly, this is better than nothing, which is the approach taken by many.

Unfortunately, toes move significantly during the act of walking. Consequently, the buddy-taping technique allows more motion and less stability. This is not optimal in the face of a fracture….even if it is “just a toe.” Securing the injured digit to the foot provides greater stability to the site of the fracture. This can be done with the application of special wrap securing the toe to the forefoot (as opposed to the much less stable, neighboring toe).

In addition to a stable wrap (more accurately referred to as a soft cast), frequently recommended is better immobilization of the whole foot, perhaps with a cast boot or, more commonly, a medical shoe, aka a post op shoe (or surgical shoe since it’s typically prescribed after most any foot surgery). There are many benefits from this pantheon of fashion, the post-op shoe. This is the open-toed, Velcro-strapped, black medical shoe people wear after some form of trauma, be it accidental or surgical. The stiff, nearly solid sole of the shoe changes foot motion in gait, reducing stress to damaged structures, and is especially helpful at reducing foot joint motion.

But does every digital injury or stubbed toe need to be treated? An accurate diagnosis is the first answer to the question of treatment. Too often, the extent of the damage is never specifically determined. Just because the toe isn’t bent off at some crazy angle does not mean a significant injury hasn’t occurred. As might be expected, a positive identification requires radiographs, a.k.a. the common x-ray.

Any broken bone, be it a toe or a leg, that moves too much during the healing process, will tend to experience complications with this complex chain of events. One possibility is a non-union in which bone tissue never grows across the gap created by the break. These can be painful and lead to instability of the toe. If the injury is a sprained toe joint and there is no fracture, inadequate bracing of the toe may prevent the damaged ligament from healing correctly, resulting in a toe that dislocates chronically and without much provocation.

It can be hard to know whether professional care is needed for a toe injury. Some indicators include excessive bruising, significant pain, or some level of deformity. Many people experience a blunt trauma injury to a toe and have no long-term consequences. But some do, and experience problems thereafter that were easily prevented. When in doubt, check it out. And immobilize, it’s a technique used by humanity for thousands of years. And it still works.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.