Toe, Foot, and Ankle Injuries

Overview

Everyone has had a minor toe, foot, or ankle injury that caused pain or swelling. Most of the time our body movements don't cause problems. But sometimes symptoms develop from everyday wear and tear, overuse, or an injury.

Toe, foot, or ankle injuries most often occur during:

• Sports or recreational activities.
• Work-related tasks.
• Work or projects around the home.

In children, most toe, foot, or ankle injuries occur during sports, play, or falls. The risk for injury is higher in sports with jumping, such as basketball. And it's higher in sports with quick direction change, such as soccer or football. Any bone injury near a joint may injure the growth plate (physis) in a child. It needs to be checked.

Certain athletes, such as dancers, gymnasts, and soccer or basketball players, have a higher risk of toe, foot, or ankle injuries.

Older adults are at higher risk for injuries and fractures. That's because they lose muscle mass and bone strength as they age. They also have more problems with vision and balance. These problems increase their risk of injury.

Most minor injuries will heal on their own. Home treatment is usually all that's needed.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, or a fall. It can also happen if you twist, jerk, jam, or bend a limb abnormally. Your pain may be sudden and severe. Bruising and swelling may start soon after your injury. Acute injuries include:

Overuse injuries

Overuse injuries occur when too much stress is placed on your joint or other tissue. It often happens when a person "overdoes" an activity or repeats the same activity over and over. Overuse injuries include:

• Retrocalcaneal bursitis, which is inflammation of the bursa. It causes swelling and tenderness of the back of the heel and ankle. Pain usually gets worse while you are wearing shoes and during activity. Pain improves during rest.
• Achilles tendinitis or tendinosis (tendinopathy). This is the breakdown of soft tissues in and around the Achilles tendon, which connects the calf muscles to the heel bone.
• Stress fracture. This is a hairline crack in a bone.
• Plantar fasciitis. This is inflammation of the plantar fascia, a broad, flat ligament on the bottom of the foot. This ligament extends from the front of the heel to the base of the toes. It helps maintain the arch of the foot.
• Metatarsalgia, which is pain in the front (ball) of the foot.

Treatment

Treatment for your toe, foot, or ankle injury may include first aid (such as using a brace, splint, or cast), a special shoe (orthotic device), physical therapy, or medicine. In some cases, surgery is needed. Treatment depends on:

• The location and type of injury, and how bad it is.
• When the injury occurred.
• Your age, your overall health, and your activities (such as work, sports, or hobbies).

Self-Care

First aid for a possible broken bone

Most minor toe, foot, or ankle injuries will heal on their own. Home treatment is usually all that's needed. But if you think that you might have a more severe injury, use first aid until you can be seen by a doctor.

• Clean a skin wound as soon as you can. This will help prevent infection, scarring, and tattooing of the skin from dirt left in the wound.
• If a bone is sticking out of your skin, don't try to push it back into your skin. It's better to leave the bone alone. Cover the area with a clean bandage.
• Control bleeding with direct pressure to the wound.
• Remove all anklets or rings right away. It may be hard to remove the jewelry after swelling starts. This can then cause other serious problems, such as a compressed nerve or restricted blood flow.
• Try to free your trapped toe or foot if it's stuck in an object, such as a pipe, toy, or jar. Don't try to force it out, because that could cause more swelling.

Treating a broken toe

Some broken toes can be cared for at home. Try using ice, elevating the foot, and resting.

Treatment depends on which toe is broken, where in the toe the break is, and how bad the break is. Medical treatment is needed more often for a broken big toe than for the other toes. If you don't have diabetes or peripheral arterial disease, your toe can be buddy-taped to the healthy toe next to it. Put some soft padding, such as felt or foam, between your toes before you tape them together. This helps protect the skin. Your injured toe may need to be buddy-taped for 2 to 4 weeks to heal. If your injured toe hurts more after buddy taping it, take the tape off.

Other treatment may be needed. Your doctor may recommend:

• Wearing a splint or cast to keep the toe stable and help it heal.
• Surgery. This may be an option for a bad break.

A fracture that isn't treated may cause long-term pain, limited movement, and deformity.

Caring for a minor foot or ankle injury

Try the following tips to help relieve foot or ankle pain, swelling, and stiffness.

• Clean a skin wound as soon as you can.

  This will help prevent infection, scarring, and tattooing of the skin from dirt left in the wound.

• Check your feet every day.

  Take a look at your feet to see if you have pressure spots, redness, or blisters.

• Remove all jewelry.

  Remove rings, anklets, and any other jewelry that goes around your leg or ankle. It will be hard to remove the jewelry after swelling starts.

• Rest.

  It's important to rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.

• Use ice.

  Put ice or a cold pack on the affected area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake).

• Wrap the injured or sore area.

  Compression, or wrapping the area with an elastic bandage (such as an Ace wrap), will help reduce swelling. Don't wrap it too tightly, because that can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, and swelling in the area below the bandage.

• Elevate the injured or sore area.

  Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the area on pillows while you apply ice and anytime you sit or lie down.

• Avoid more swelling.

  For the first 48 hours after your injury, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.

• Apply heat.
  • After 2 or 3 days, you can try applying heat to the area that hurts. Types of heat therapy include microwavable packs and disposable heating patches.
  • Apply heat for 10 to 20 minutes at a time.
  • You might also try switching between cold and heat.
• Walk on your affected foot.

  Walk or bear weight on your affected foot as long as it isn't painful.

• Rub the area.

  Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the injured area if it causes pain.

• Start exercises.

  Ask your doctor about exercises using the MSA process (gentle exercise). MSA stands for movement, strength, and alternate activities.

• Don't smoke or use other tobacco products.

  Smoking slows healing because it decreases blood supply and delays tissue repair.

If you need to use a wrap for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.

Signs of possible abuse

Most injuries are not caused by abuse. But bruises are often the first sign of possible abuse. Suspect physical abuse of a child or vulnerable adult when:

• Any injury cannot be explained or does not match the explanation.
• Repeated injuries occur.
• Explanations change for how the injury happened.

You may be able to prevent further injuries by reporting abuse. Seek help if:

• You suspect child abuse or elder abuse. Call your local child or adult protective agency, police, or a health professional, such as a doctor, nurse, or counselor.
• You or someone you know is experiencing intimate partner violence (IPV).
• You have trouble controlling your anger with a child or other person in your care.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse pain or swelling.
• New signs of infection, such as redness, warmth, pus, or a fever.
• New or worse numbness, tingling, or cool and pale skin.
• Movement or strength decreases.
• Symptoms occur more often or are more severe.

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