TOE INJURY

Injury Definition

  • Injury the skin or nail of the toe.
  • Injury to a bone, muscle, joint or ligament of the toe.

Types of Injuries

  • Cuts and Scratches: Superficial cuts (scratches) only extend partially through the skin and rarely become infected.  Deep cuts (lacerations) go through the skin (dermis).
  • 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.
  • Fractures (broken bones)
  • Dislocations (bone out of joint)
  • Jammed 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.
  • 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 under < 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


WHEN TO CALL YOUR DOCTOR FOR TOE INJURY

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
  • First Aid: Apply direct pressure to the entire wound with a clean cloth.

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 a 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 9am and 4pm) 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

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's 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 every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • 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.
    • 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 or develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2004 David Thompson, M.D. FACEP

Reviewed 8/2004

Revised 8/2004

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