What Is A Stubbed Toe?

Overview

A stubbed toe is a common and often painful injury. It usually occurs when the toe is forcefully hit against a hard object. Such injuries are relatively common, especially in children and during summer months when not wearing shoes.¹ These injuries are usually minor, but can cause significant discomfort and inconvenience to the patient, especially while walking. 

However, on a more serious level, stubbing your toe, especially the big toe, can be a cause of open fractures which may initially not be identified, and which may cause infections of the bone (osteomyelitis).¹

In this article we will attempt to understand the causes, clinical features, and appropriate treatment options for a stubbed toe.

Causes of a Stubbed Toe

A stubbed toe usually occurs when the toe is jammed against a hard surface like furniture or walls with significant force. There may be a couple of reasons for repeatedly stubbing your toe and hurting yourself which you can control:

• Accidental collisions with furniture might happen as a result of clumsiness due to misjudgment of distances or degree of movements
• Inadequate lighting: Poorly lit spaces can make it challenging to see obstacles, increasing the risk of stubbing your toe
• Barefoot Walking: Walking barefoot increases the likelihood of toe injuries, because there is no protective covering over your toe

Signs and symptoms of a stubbed toe

The mechanism of stubbing the big toe impacts the severity and type of symptoms. Stubbing injuries of the big toe usually pushes the distal phalanx into forced hyperflexion and is often associated with injuries of the distal phalanx (most distant bone of the toe). While a variety of symptoms may be seen, the common ones include:

• Swelling: The injured toe might become swollen due to inflammation of the surrounding tissue
• Bruising: Discoloration or bruising around the affected area might develop as a result of broken blood vessels in the region following the impact
• Difficulty Walking: Because of the big toe's role in bearing weight, maintaining balance, and foot motion, fractures of this toe are more troublesome than other toe fractures. Thus, they can cause deformity, decreased range of motion, and balance problems which can impair your easy walking and daily activities.³

More severe signs may be noticed in case of a fracture (usually a Salter-Harris Type-1 fracture), which one has to be vigilant of.² These include:

• Bleeding at the base of the nail
• Laceration proximal to the nail fold
• Signs of a displaced fracture which may be noticed by your healthcare professional
• Feeling bone protruding from the wound 

Unrecognised open fractures can lead to mistreatment and consequently infections of the bone (osteomyelitis) or growth disturbances in the long term in children. 

Types of injuries from a stubbed toe

• Soft tissue injuries are common in most cases. A stubbed toe results in injuries to the soft tissue surrounding the bone causing signs like bruising or swelling even without significant structural damage
• Fractures: Severe impact can cause a toe bone to break or fracture. This might be accompanied by more intense pain, bleeding and visible deformity and displacement

Management of stubbed toe

The treatment of a stubbed toe depends on the type and severity of injury as well as how soon you see your healthcare provider. In most uncomplicated situations you may be advised to:

• Rest the foot: This can be done by reducing pressure and weight on the affected toe by resting and avoiding any strenuous activities
• Ice the foot: Applying an ice pack or ice wrapped in a cloth to the injured area can help reduce inflammation and reduce pain
• Elevation of the foot: Elevating the injured foot slightly can also help in reducing swelling

While most stubbed toes heal on their own with home care, it's essential to seek medical attention if you notice any of the previously mentioned signs of fracture such as:

• Intense or worsening pain that doesn't subside after initial care 
• Visible deformity or dislocation of the stubbed toe.
• Persistent difficulty walking or bearing weight on the injured foot.
• Bleeding from the toenail

The healthcare staff may prescribe antibiotics and medications for pain, clean and dress the wound, and in some cases may escalate for splinting or even surgery.² You might also be prescribed investigations like X-rays to evaluate the extent of the injury and plan the treatment methodology.

Some of the interventions suggested include:

• Pain management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help alleviate discomfort
• Rest and elevation: Resting the foot and keeping it elevated can aid in reducing swelling
• Splinting the toe: Buddy taping the injured toe to its adjacent toe or using a splint provides support and protection, facilitating healing

Summary

A stubbed toe is usually seen as a minor inconvenience, but it can cause significant discomfort. In some cases, it may even lead to more severe injuries like fractures. Prompt and appropriate care, including rest, ice, elevation, and pain management, can often facilitate healing. However, it is important to seek medical attention for persistent pain even after rest and ice, any visible deformities, or difficulty moving the foot or walking. This can ensure proper assessment and treatment, especially in cases of fractures or dislocations. Preventive measures, including ensuring adequate lighting and wearing protective footwear, can help reduce the risk of toe-stubbing accidents.