Post-Cast Removal: Swelling and Pain in Your Toe

Swelling and throbbing pain after removing the cast?

Hello, I was in a car accident on November 6, which resulted in a fracture of the fifth toe and slight displacement of the fourth toe on my left foot.
I had a cast applied for stabilization.
During my follow-up appointment on December 3, the doctor mentioned that the healing process was going well and that I could remove the cast, although keeping it on for another week would be safer.
I chose to keep the cast on for an additional week.
However, today I felt a foreign body sensation in my heel, so I removed the cast early.
After removing it, the fifth toe is still swollen and has a bit of a throbbing pain, and I also experience pain on the sole of my foot between the fourth and fifth toes.
I would like to know if the current swelling of the fifth toe is normal and whether I need to reapply the cast.

Li, 20~29 year old female. Ask Date: 2018/12/10

Dr. Chen Yongxue reply Orthopedics

Hello, after a fracture, a fixation period of approximately four to six weeks is required.
Of course, the longer the fixation period, the higher the possibility of joint stiffness.
Therefore, for fractures of the extremities (hands and feet), the principle is to fix for four weeks.
After that, it is important to be cautious and avoid re-injuring the affected limb, as early mobilization can reduce the chances of joint stiffness.
However, please be very careful not to injure the affected limb again; this is very important.
Thank you.

Reply Date: 2018/12/10

More Info

After a fracture and subsequent cast removal, it is not uncommon to experience swelling and pain in the affected area, particularly in the toes. In your case, the swelling and pain in your fifth toe following the removal of the cast can be attributed to several factors related to the healing process and the immobilization period.

Firstly, when a bone fractures, the body initiates a healing response that includes inflammation. This inflammation can cause swelling, which may persist even after the cast is removed. The cast itself restricts movement and circulation, and once it is removed, the muscles and soft tissues may take some time to regain their normal function and circulation, leading to further swelling and discomfort.

Additionally, the pain you are experiencing in the area between your fourth and fifth toes could be due to a few reasons:
1. Soft Tissue Healing: The soft tissues, including ligaments and tendons, may have been affected during the injury and the immobilization period. As they heal, they can be sensitive and painful, especially when pressure is applied.

2. Joint Stiffness: After a period of immobilization, the joints can become stiff. This stiffness can lead to discomfort when you start to move the toes again. Gentle range-of-motion exercises can help alleviate this stiffness over time.

3. Nerve Sensitivity: Sometimes, nerves can become sensitive after an injury, leading to sensations of pain or discomfort that may feel like a sharp or stabbing pain.

4. Increased Activity: If you have resumed normal activities too quickly after cast removal, this can exacerbate swelling and pain. It is essential to gradually increase activity levels to allow the body to adjust.

Regarding your question about whether the swelling is normal and if you should reapply the cast, here are some considerations:
- Swelling: Mild swelling can be expected after cast removal, especially if the cast was on for an extended period. However, if the swelling is significant, worsening, or accompanied by severe pain, it may indicate complications such as a re-fracture or other issues that need medical attention.

- Reapplying the Cast: Generally, reapplying a cast is not the standard approach unless there is a specific reason to immobilize the area again. Instead, your doctor may recommend a supportive shoe or a walking boot to provide stability while allowing for some movement.
- Consultation: It is advisable to follow up with your healthcare provider to assess the swelling and pain. They may perform a physical examination and possibly imaging studies to ensure that the fracture is healing correctly and that there are no complications.

In the meantime, here are some self-care strategies you can implement:
1. Rest: Avoid putting weight on the affected foot as much as possible to allow for healing.

2. Elevation: Keep your foot elevated to help reduce swelling.

3. Ice Therapy: Applying ice to the swollen area can help reduce inflammation and numb the pain. Use ice packs for 15-20 minutes several times a day.

4. Gentle Movement: Once the initial swelling decreases, gentle range-of-motion exercises can help improve flexibility and reduce stiffness.

5. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain and reduce inflammation.

In conclusion, while some swelling and pain after cast removal can be normal, it is essential to monitor your symptoms closely. If the swelling persists or worsens, or if you experience significant pain, it is crucial to seek medical advice promptly to rule out any complications. Your healthcare provider can guide you on the best course of action for your recovery.

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