What a broken toe is
The big toe has two small bones (phalanges) and the smaller toes usually three, though the little toe sometimes has two. Most breaks come from something heavy dropped on the foot or from stubbing the toe end-on; bending the toe back, and stress fractures from repeated load, are less common.
A sprained toe joint, a bruise, a dislocated joint or a tendon injury can look and feel the same, which is why the NHS says not to worry if you can't tell a broken smaller toe from a bruised one: the treatment is usually the same.
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Who breaks a toeEmerging evidence
Toe fractures are among the commonest fractures that family doctors see: 8% and 9% of all fractures in two US practices. In US emergency departments there were 921,033 toe fractures over 10 years, 59% in women and girls, peaking at ages 10 to 14.
Smaller toes break about 4 times as often as the big toe. Hospital figures look different, because big toes are sent to hospital: in one hospital series of 339 people, 38% had broken the big toe and 30% the little toe, and 76% of breaks came from a stub or a crush. In a Manchester virtual fracture clinic, where a specialist team reviews the X-ray and advises by phone, 71% of 56 people surveyed had broken the big toe.
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How it's recognised, and when an X-ray matters
The NHS lists a toe that's bruised or red (which can be harder to see on brown and black skin), painful and swollen, and difficult to walk on. A doctor looks for tenderness at one spot on the bone, or pain when the toe is gently pushed along its length.
A suspected broken big toe, a toe pointing at an odd angle, a bone through the skin, tingling or numbness, or a child's toe injury goes to A&E, where it's X-rayed. The X-ray checks for a break into a joint, whether a big toe break is stable and, in children, the growth plate, because these change the treatment. For a smaller toe that's straight and has no wound, follow-up X-rays generally don't change the treatment.
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How long it takesEmerging evidence
The NHS says broken toes usually heal within 4 to 6 weeks, but it can sometimes take several months. NHS fracture clinic leaflets expect walking and toe bending to be back to normal by about 6 weeks, the break to have healed somewhere between weeks 6 and 12, and mild aching and swelling, often worse at the end of the day, for 3 to 6 months. An older leaflet, past its expiry date, gives 6 to 12 weeks for healing.
Most broken toes do well. In one foot and ankle fracture clinic, toe fractures were 9% of new referrals, only 2 of 65 people needed an operation, and no one developed a troublesome crooked toe over the next 2 years. In the series of 339, all treated without surgery, the 141 people who replied a median of 27 months later had a median foot score of 100 out of 100, whichever toe was broken. In the Manchester virtual clinic, the median recovery time was 6 weeks.
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Children: the stubbed big toe that bleedsEmerging evidence
The NHS asks parents not to treat a child's toe themselves but to take them to an urgent treatment centre or A&E. Children's toe bones have growth plates, and many breaks through a growth plate need a specialist.
One injury is easy to miss. A stubbed big toe that bleeds from around the nail, or whose nail has lifted out of its fold, can be a break through the growth plate at the tip of the toe that is open to the outside through the nail bed (a Seymour or Pinckney fracture). It's treated as an open fracture, with antibiotics and cleaning, because delay risks infection of the bone and problems with growth. This evidence comes from reviews and case reports.
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Diabetes, numb feet and bones
The NHS says see a GP if you have diabetes and have injured your toe, because foot problems can be more serious. With numb feet a break may hurt less than you'd expect, so check the foot and get a wound, or a hot, swollen foot, seen the same day.
A broken toe from a stub or a dropped weight isn't a sign of weak bones: NICE (the National Institute for Health and Care Excellence) says finger and toe fractures show minimal or no link with reduced bone strength.
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