Injury to the Big Toe: Bruising, Pain, and Treatment Options

Bruised and swollen toe?

A few days ago, I accidentally stubbed my toe against a wall while practicing, and my shoes were also ill-fitting.
As a result, my big toe is completely bruised, and there are bruises on the skin next to the nail.
It hurts from time to time, and it even hurts to walk.
Should I go to the hospital for treatment? Do I need to have the nail removed? If I have the nail removed, can I still wear basketball shoes to practice? Can I continue practicing without treatment? Or is it sufficient to apply ice or heat? I've heard from friends that nail removal is necessary; are there any other related guidelines?

Da Er, 10~19 year old female. Ask Date: 2021/08/14

Dr. Ke Fangxu reply Surgery

If there is subungual hematoma caused by trauma without pain or swelling, it is acceptable not to remove the toenail.
If there is swelling but no infection, simple aspiration and drainage are sufficient.
However, if there are signs of infection such as redness, swelling, and heat, the toenail should be removed to control the bacterial infection.
If toenail removal is necessary, it is generally recommended to rest for a week and avoid vigorous activities.

Reply Date: 2021/08/14

More Info

Injuries to the big toe, especially those resulting from trauma such as hitting it against a wall, can lead to bruising, pain, and sometimes more serious complications. Based on your description, it sounds like you have sustained a contusion (bruise) to your big toe, which is causing pain and discoloration. Here’s a comprehensive approach to understanding your injury and the treatment options available.

Symptoms and Initial Assessment
The symptoms you are experiencing—bruising, pain, and discomfort while walking—are common after a traumatic injury to the toe. The presence of bruising indicates bleeding under the skin, which can occur due to damaged blood vessels. If the pain is severe, if you have difficulty moving the toe, or if there is significant swelling, these could be signs of a more serious injury, such as a fracture or a nail bed injury.

When to Seek Medical Attention
You should consider visiting a healthcare provider if:
1. Severe Pain: If the pain is intense and not improving with rest and home care.

2. Inability to Move the Toe: If you cannot move your big toe or if it feels unstable.

3. Nail Damage: If the toenail is loose, discolored, or if there is a lot of blood under the nail (subungual hematoma).

4. Signs of Infection: If you notice increased redness, warmth, swelling, or pus around the toe.

Treatment Options
1. RICE Method: For minor injuries, you can start with the RICE method:
- Rest: Avoid putting weight on the injured toe.

- Ice: Apply ice packs to the toe for 15-20 minutes every hour to reduce swelling and pain.

- Compression: Use a soft bandage to compress the area, but not too tightly as to cut off circulation.

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

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

3. Nail Care: If there is significant bruising under the toenail and it is causing severe pain, a healthcare provider may need to relieve the pressure by draining the blood (this is often done with a small needle). In some cases, if the nail is severely damaged, it may need to be removed.
4. Footwear: It’s crucial to wear appropriate footwear that provides support and cushioning. Avoid tight shoes that can exacerbate the injury. If you need to practice basketball, consider using shoes that have a wider toe box or are specifically designed for foot injuries.

Returning to Activity
If your toe is only bruised and the pain is manageable, you might be able to return to basketball practice after a few days of rest and care. However, if the pain persists or worsens, or if you have any doubts about the stability of your toe, it’s best to consult a healthcare professional before resuming any physical activity. Continuing to play with an untreated injury could lead to further damage.

Conclusion
In summary, while minor bruising and pain can often be managed at home, it’s essential to monitor your symptoms closely. If the pain is severe, if you notice any signs of infection, or if you have concerns about the integrity of your toenail, seek medical attention. Proper care and attention to your injury will help ensure a quicker recovery and prevent complications that could sideline you from your basketball activities.

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