Toe Issues After Fracture: Causes and Treatment Options

Toe problems

I would like to ask the doctor, on March 19, I had a fracture of the fifth metatarsal in my right foot and was in a full cast for three and a half weeks, followed by a half cast for two weeks.
I haven't moved my toes at all, and now, 74 days later, I have noticed a small round swelling on my right fourth toe, which causes my third toe to not touch the ground properly when walking, pressing against the fourth toe.
Could this be due to prolonged immobility leading to fibrosis, resulting in poor mobility and extension of the fourth toe? (Because when I put weight on my left foot, the fourth toe extends outward and does not get stuck under the third toe.) Or could there be other reasons? I consulted an orthopedic doctor, and he said my bones are fine, but what could be the cause of this swelling? Could you please clarify this for me? Should I apply heat or ice? It seems that heat therapy may help alleviate fibrosis, and if I engage in exercise, it shouldn't worsen, right? Is there a way for me to send you a picture for your review?

Su Ruiyu, 10~19 year old female. Ask Date: 2014/06/11

Dr. Chen Wayda reply Rehabilitation

It is more appropriate to use heat therapy.
Whether fibrosis is present should be assessed by the physician during the outpatient visit for a more accurate clinical judgment.

Reply Date: 2014/06/11

More Info

It sounds like you are experiencing some significant issues with your right foot after a fracture of the fifth metatarsal. Based on your description, it seems that you have been immobilized for an extended period, which can lead to stiffness and swelling in the toes. Let's break down your concerns and provide some insights into potential causes and treatment options.

Causes of Toe Issues After Fracture
1. Stiffness and Fibrosis: After prolonged immobilization, it is common for joints and soft tissues to become stiff. This stiffness can lead to a condition known as fibrosis, where the connective tissue becomes thickened and less flexible. This could explain why your fourth toe is not moving as freely as it should, especially if it has been inactive for several weeks.

2. Swelling: The swelling you are experiencing in the fourth toe could be due to several factors, including:
- Post-Traumatic Edema: After a fracture, it is normal for swelling to persist for some time, especially if the area has been immobilized.

- Increased Pressure: If the fourth toe is being compressed by the third toe due to its limited movement, this could lead to localized swelling.

- Nerve or Vascular Issues: Sometimes, swelling can be related to nerve irritation or vascular issues, particularly if there is any compression in the area.

3. Alignment Issues: If the toes are not properly aligned due to the swelling or stiffness, this could lead to abnormal pressure distribution when walking, causing discomfort and further complications.

Treatment Options
1. Physical Therapy: Engaging in physical therapy can be highly beneficial. A physical therapist can guide you through exercises designed to improve flexibility, strength, and range of motion in your toes and foot. This is crucial for addressing any stiffness and ensuring proper function.

2. Heat vs. Ice:
- Ice Therapy: Ice can help reduce swelling and numb the area, which may provide relief from pain. It is generally recommended to apply ice for 15-20 minutes several times a day, especially if the swelling is significant.

- Heat Therapy: Heat can be beneficial for stiffness and promoting blood flow to the area. However, it should be used cautiously, particularly if there is swelling, as it may exacerbate the condition. If you find that heat helps relieve stiffness without increasing swelling, it may be appropriate to use.

3. Gentle Mobilization: If your doctor has cleared you for movement, gently moving your toes and foot can help improve flexibility. Start with passive movements (moving your toes with your hands) and gradually progress to active movements as tolerated.

4. Footwear: Ensure that you are wearing supportive footwear that accommodates any swelling and provides adequate space for your toes. Avoid tight shoes that could exacerbate the issue.

5. Follow-Up with Your Doctor: Since your orthopedic doctor has indicated that the bones appear to be fine, it may be helpful to discuss your ongoing symptoms further. If the swelling persists or worsens, or if you experience significant pain, a follow-up appointment may be necessary to rule out any complications.

Conclusion
In summary, the issues you are experiencing with your fourth toe may be related to stiffness and swelling following your fracture and immobilization. Engaging in physical therapy, using appropriate heat or ice therapy, and ensuring proper footwear can help alleviate your symptoms. If your condition does not improve, or if you have further concerns, it is essential to consult your healthcare provider for a more tailored treatment plan.
If you have any images or further details you'd like to share, please consult your healthcare provider directly, as they can provide the most accurate assessment based on visual examination.

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