Toe Injury

Symptoms

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 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
• PUNCTURE WOUND to toe
• SPLINTER OR SLIVER in toe
• SKIN INJURY (Cuts, Scrapes, Bruises) of toe

---

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 cup of ice water (to keep cool and preserve tissue).

Should I Call?

WHEN TO CALL YOUR DOCTOR

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 9 am and 4 pm) 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

Care at Home

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 is 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.

Photo Example

First Aid - Amputated Finger or Toe - Transport

• Step 1: Briefly rinse amputated part with water (to remove any dirt)
• Step 2: Place amputated part in plastic bag (to protect and keep clean)
• Step 3: Place plastic bag containing the part in a container of ice (to keep cool and preserve tissue).

Note: Take patient and amputated part to emergency department immediately.

First Aid - Bleeding Toe

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth.

First Aid - Removing a Splinter

You can remove splinters, larger slivers, and thorns with a needle and tweezers. Check the tweezers beforehand to be certain the ends (pickups) meet exactly. (If they do not, bend them.) Sterilize the tools with rubbing alcohol or a flame.

Clean the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. Be careful not to push the splinter in deeper. If you don't have rubbing alcohol, use soap and water, but don't soak the area if FB is wood (Reason: can cause swelling of the splinter).

Remove the splinter:

• Step 1: Use the needle to completely expose the large end of the sliver. Use good lighting. A magnifying glass may help.
• Step 2: Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.