Open Toe Fracture

Your big toe is broken (fractured) and you have a nearby cut (laceration), puncture, or deep scrape. This causes pain, swelling, and bruising at the site of the injury. Because of the open injury, you are at risk for an infection in the skin and bone. You will be given antibiotics to lower the risk for infection.

Any cut will take about 10 days to heal. The fracture takes about 4 weeks to heal. Toe injuries are often treated by taping the injured toe to the next one (buddy taping) or using a protective boot. This protects the injured toe and holds it in position.

If the toenail has been severely injured, it may fall off in 1 to 2 weeks. It takes up to 12 months for a new toenail to grow back.

Home care

These guidelines will help you care for your wound at home:

  • You may be given a cast shoe or boot to wear to keep your toe from moving. If not, you can use a sandal or any shoe that doesn’t put pressure on the injured toe until the swelling and pain go away. If using a sandal, be careful not to strike your foot against anything. Another injury could make the fracture worse. If you were given crutches, don’t put your full weight on the injured foot until you can do so without pain.

  • Keep your foot elevated to reduce pain and swelling. When sleeping, put a pillow under the injured leg. When sitting, support the injured leg so it's above your waist. This is very important during the first 2 days (48 hours).

  • Put an ice pack on the injured area. Do this for 20 minutes every 1 to 2 hours the first day for pain relief. You can make an ice pack by wrapping a plastic bag of ice cubes in a thin towel. As the ice melts, be careful that any cloth or paper tape doesn’t get wet. Continue using the ice pack 3 to 4 times a day for the next 2 days. Then use the ice pack as needed to ease pain and swelling.

  • You may use acetaminophen or ibuprofen to control pain, unless another pain medicine was prescribed. If you have chronic liver or kidney disease, talk with your healthcare provider before using these medicines. Also talk with your provider if you’ve had a stomach ulcer or gastrointestinal bleeding.

  • If buddy tape was used and it becomes wet or dirty, change it. You may replace it with paper, plastic, or cloth tape. Cloth tape and paper tapes must be kept dry. Keep the buddy tape in place for 4 weeks, or as instructed.

  • Keep the wound clean and dry. If a bandage was put on and it becomes wet or dirty, replace it. Otherwise, leave it in place for the first 24 hours.

  • If stitches were used, clean the wound every day:

    • Take off the bandage. Wash the area with soap and water. Use a wet cotton swab to loosen and remove any blood or crust that forms.

    • After cleaning, put a fresh bandage on.

    • You may take off the bandage to shower as usual after the first 24 hours. But don’t soak the area in water until the stitches are removed. Don’t take a tub bath or go swimming during this time.

  • If surgical tape was used, keep the area clean and dry. If it becomes wet, blot it dry with a towel.

  • Take any prescribed antibiotics until they are gone.

  • You may go back to sports or physical activities after 4 weeks, or when you can run without pain. Stay away from the activity that led to the injury during this time. Choose another activity in the meantime. Gradually go back to your usual activities. Stop any activities if the pain comes back.

  • You may need surgery for more severe injuries, but this is rare. If so, this is done by an orthopedic surgeon. This is a surgeon who specializes in treating bone, muscle, joint, and tendon problems.

Follow-up care

Follow up with your healthcare provider, or as advised. This is to make sure the bone is healing the way it should. Most skin wounds heal within 10 days. But even with proper treatment, a wound infection may sometimes occur. That’s why it’s important to check the wound every day for signs of infection listed below.

Stitches should be removed in 7 to 14 days. If surgical tape closures were used, you can take them off yourself if they haven’t fallen off after 10 days.

You will be told of any new findings that may affect your care.

When to get medical advice

Call your healthcare provider right away if any of these occur:

  • Redness, warmth, swelling, drainage from the wound, or foul odor

  • Chills or fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider

  • Stitches come apart or surgical tape closures fall off before 7 days

  • Wound edges reopen

  • Bleeding that is not controlled with direct pressure

  • Toe becomes cold, blue, numb, or tingly

  • Pain get worse or isn’t well controlled by prescribed pain medicines

  • You can’t put weight on your foot 

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