Why is my fractured toe painful and swollen even after a back slab and ankle boot treatment?

Question

Hi doctor,

I got injured three months ago. After the injury, I am experiencing pain in my fifth toe. I got a fracture of the middle phalanx of the fifth toe. A back slab was applied as a primary line of treatment, and then after a month, an ankle boot was placed as management. Even after two months of treatment, the toe is still swollen and painful, especially while walking. My current medications are Diclofenac spray and Paracetamol tablet.

Kindly advice.

Answer 1

Hello,

Welcome to icliniq.com.

You had a fracture in the proximal phalanx of the fifth toe, and it is undisplaced. You then spent two months splinted and slabbed. The most likely cause of pain at this stage can be-

1) Stiffness which gets worse with splinting for a more extended period. I would not keep the splint for such an extended period. Instead, I treat you with a buddy splint and an open-toe box shoe or a loose sandal.

2) CRPS TYPE II (complex regional pain syndrome) from the injury itself, but this is likely to lead to swollen foot entirely rather than the fifth toe alone.

I recommend you warm soak the toe and gently mobilize it, try ice massage, keep the foot above the hip level when resting. And take anti-inflammatory tablets and vitamin C to help better. Can you send me a picture of both feet to see how swollen it is?

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Thanks for sending the pictures (attachments removed to protect the patient’s identity). In the picture, I can see that the little toe is not lying in the same plane as the other toes, there are normal skin creases in the base of the toe and the foot itself, and also mild swelling is noted, but I think the cause of the toe standing apart is a combination of swelling and the deformation of the bone from the fracture. Swelling will subside with time, and the shape will improve but may not return to the exact previous form. There is no evidence of CRPS as the foot is not swollen. I would suggest you take anti-inflammatory tablets if you feel that the pain persists and perhaps walk with more pressure on the heel. I can see you practicing for a marathon in not so distant future.

Thank you.