Feet > Broken Toe > Treatments

   Open Reduction, Internal Fixation

Treatment Introduction

If your broken toe cannot be positioned properly, you may be a candidate for surgery. Surgery often can help patients with a condition called "floppy toe." A floppy toe has dislocated in an awkward position after a fracture and is unstable in the joint. You also may be a candidate for surgery if your toe fractures in two or more fragments, or when the fracture lines touch a joint in your toe. A fracture in the joint itself has a high risk of dislocation. Your surgeon can fix your broken toe in place with wires that help hold your toe steady as it heals. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

The actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or an assistant about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your ankle area may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your post-operative shoe when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Open reduction and internal fixation of your broken toe can take one to two hours to perform. Regional anesthesia typically is injected into your foot to numb your toe, and you usually are sedated so you sleep through the procedure.

   An incision usually is made along your toe, depending on the specific location of the fracture.

   If soft tissues are blocking your toe from returning to its proper position, your surgeon may need to manipulate your toe’s tendons or the joint capsule surrounding your toe’s joint with your foot.

   Your surgeon manually positions your toe where it joins your foot.

   Your surgeon then tests your toe’s motion. If it is stable in the joint, your surgeon may repair the soft tissues with sutures and close the incision.

   If your toe cannot maintain its position, a strong, thin wire, called a Kirschner wire, is then inserted so it passes through your toe and your long foot bone. The wire stabilizes your toe in the metatarsophalangeal joint.

   Soft tissues are repaired with sutures and your incision is stitched closed.

   Your foot is wrapped in compression dressing, which covers your toe incision. Your broken toe is normally taped to the healthy toe next to it.

   Your foot is placed into an open-toe sandal that has a hard bottom so your toes cannot bend and you are taken to the recovery room.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Recovery Room

After surgery to stabilize your broken toe, you will be transported to the recovery room where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your foot and ankle will be elevated when you wake up. The post-surgery shoe is open-toed and soft, bulky dressings cover your incision and hide it from view. There usually is minimal bleeding after surgery. After surgery, you usually experience some pain and adequate pain medications will be prescribed for you. You will be given intravenous (IV), oral, or intramuscular pain medications as needed. You usually can have visitors about a half-hour after surgery if your physician feels you are in a stable condition. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you are ready to leave the hospital. Many patients can return home the same day after surgery. Occasionally, you may be transported to the hospital ward for further post-operative care, depending on the amount of pain management you need. Before heading home, your physician will give you instructions for wearing the special post-surgery shoe. The shoe is an open-toe sandal with a stiff, plastic sole that does not bend. You will also meet a physical therapist who instructs you in the use of crutches so you can keep weight off your toe for about three weeks. Arrange for someone to take you home from the hospital, as you will be unable to drive a car. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

After open reduction and internal fixation of your broken toe, you may need to be on crutches for about three weeks. Rest as much as possible with your foot elevated above the level of your heart. This helps blood drain away from your toe and can control swelling. Keep the bandage around your toe dry. Shower with your foot wrapped in a plastic bag or bathe with your injured leg outside the tub. There should be little bleeding. Call your physician if you are bleeding through the bandage. It is essential to keep weight off your foot for the first few days. Everyone heals at a different pace, so use your crutches as often as necessary to avoid pain in your toe. You will rely less on the crutches as pain decreases over the course of about three weeks. Your physician also may prescribe pain medication to help ease your pain during the first few weeks. Recovery is easier when you have someone around the house who can help with any physical chores. Wear the stiff-soled shoe given to you in the hospital whenever you are moving around. A typical recovery schedule after surgery for a broken toe goes as follows:

   Three weeks – Return to your physician’s office for X-rays and removal of your sutures. The wires may be removed from your toe, depending on the type of fracture you suffered. Your physician may instruct you to "buddy tape" your broken toe to the healthy toe next to it. You will need to keep a dry gauze pad between your taped toes.

   Three to six weeks – Continue buddy taping your toe and wearing the post-surgery shoe. Change the tape and gauze as often as needed. When you apply the tape, your broken toe should be securely attached to the healthy toe but the tape should not be so tight that you lose circulation. Position the gauze pad between your toes so no skin is touching. If your skin moistens and rubs against the other toe, it could become irritated.

   Six weeks – Your physician will examine your toe again and determine if you can begin bearing weight on your foot with your toe taped. You may be able to begin walking while wearing normal shoes that have a stiff sole and extra room for your toes.

   Nine to 12 weeks – Buddy taping may be discontinued. You may be able to begin running again if your physician determines that your toe has properly healed.

v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Rehabilitation

To maintain cardiovascular fitness while your incision heals for about three weeks, upper body exercises performed while sitting or lying down, or stationary cycling may be recommended. You should begin range of motion exercises for your toes, foot, and ankle about six weeks after surgery. You may begin weight-bearing exercises with short walks and increase the duration and intensity as pain allows. When walking, wear the stiff-soled shoes given to you at the hospital so your toe will not bend. When your pain decreases, light jogging typically can begin nine to twelve weeks after surgery. Most patients can return to sports and activities about three months after surgery. Wear a stiff-soled shoe when you begin exercising. Experiment with different shoes until you find the proper fit and support in a shoe so you can exercise without pain. Athletes and people who want to improve their recovery time may benefit from visiting a physical therapist. A therapist can help you stretch your toe to restore range of motion, and can teach you specific toe exercises to strengthen the tendons and muscles that stabilize your toe. For example, your therapist may have you pick objects off the ground with your toes, or draw the alphabet on the floor with your toes. The final stage of physical therapy often involves proprioceptive exercises to restore balance and coordination in your foot. A BAPS board, made of a flat board balanced atop a ball, commonly is used to increase your muscle control. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Once your broken toe has healed, you typically can return to sports and activities without any increased risk of reinjury. Some patients, however, may have a decreased range of motion in their broken toe after surgery. Avoid tight-fitting footwear during activities. When playing contact sports, you may want to wear shoes with a sturdy, roomy toe box. Be sure to buy shoes that properly fit your foot and have extra room in the toe. Take the usual precautions to avoid direct contact with your toe. Do not carry objects that are too heavy. If you have a tendency to stub your toe, you may want to avoid walking barefoot in areas where there is furniture or other objects. v=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.