“There’s a pandemic of broken toes,” said John Keeling, an orthopedic surgeon in Chevy Chase, Md. He estimates the number of broken toes seen at his office has tripled or quadrupled.
Ben Pearl, a podiatrist whose practice is Arlington Foot and Ankle, said he has “absolutely” seen an increase in broken toes, “and the short reason is that with the pandemic, people are spending more time at home.”
Jane Andersen, a podiatrist with Chapel Hill Foot & Ankle Specialists, said she has also been treating more patients with plantar fasciitis, tendinitis and even ingrown toenails. “There are little trickle-down effects from pandemic and isolation that are happening,” Andersen said, “and broken toes is only one of them.”
Keeling, who specializes in foot and ankle surgery at the Centers for Advanced Orthopaedics, treated me for my own injury: In late October, I had stubbed a toe on a chair in my kitchen as I rushed around packing baskets and coolers with food so we wouldn’t have to go out to shop during a short hiking trip in West Virginia. I was so focused on protecting us from the coronavirus that I wasn’t paying any attention to guarding my feet from what turned out to be quite common factors leading to this rise in broken toes.
Why are people breaking toes?
Keeling has implicated Zoom meetings and online school — he has also seen an increase in broken toes among kids — for some of the breaks. Whatever his patients’ age, “they’re going around with either stocking or bare feet, and in the haste to get to the next meeting, they bump into the furniture.”
That was true in my case: I was dashing around my house, which was more cluttered than usual because of the packing and various pandemic projects I’ve been trying to get done, and I was also barefoot, because my family follows the Asian custom my husband grew up with in Hawaii of leaving shoes outside the home.
Other potential factors: Furniture might be in different places, thanks to all the workstations we’ve set up for at-home jobs and school. Or, in an effort to improve our spaces, we might be moving furniture or carrying boxes of decluttered items or packages of online purchases, which we then drop on our toes. In addition: “People are dropping bottles of wine on the big toe,” Keeling said. “A bottle of wine or a heavy jar seem to be a big killer for the great toe, or big toe.”
I understand breaking a toe by dropping something heavy on it. When I expressed surprise that just stubbing my toe caused a break, Keeling said the small bones in the toe are no match for “all the energy and momentum that’s in your leg and foot driving your foot into the corner of a wall or into the corner of a hard piece of furniture.”
What should you do about a broken toe?
I didn’t consult Keeling right after I hurt my toe. It didn’t look crooked or out of place, so I went ahead with my trip and my hiking. Years ago, when I was pregnant and suspected I had a broken pinkie toe, I hadn’t had it X-rayed. I had worried that an X-ray would be unsafe, and I was told by my OB/GYN’s office that not much could be done for a broken toe, beyond “buddy-taping” it to the neighboring toe to immobilize it.
After the continuing pain forced me to seek treatment this time, however, I learned that there are important reasons to have your toe X-rayed. It’s a good idea to know whether it’s broken or just sprained, Pearl said, because that will determine how long you should avoid work or athletic activities that put a lot of pressure on your feet. But, more essentially, if it is broken, you want to know what kind of break you have.
“If it’s very obviously bent, you need an X-ray; you need professional help to get it lined back up and in a good position to heal appropriately,” Keeling said. “If it’s not bent, you still need an X-ray, because you need to identify the nature of the fracture and whether it enters the joint and whether that joint is disrupted. Because if it heals in the wrong position, then you’re looking at problems down the road where the joint can go on to get post-traumatic arthritis, and that can become its own problem.”
“Your chances of having a long-term complication go way down if your toe heals in the right position, as opposed to healing in the wrong position,” Andersen agreed. “So, it’s really to your advantage to figure out what’s going on, and make sure it’s aligned appropriately and splinted in the appropriate fashion.”
If you’re concerned about the cost or safety of X-rays, Andersen wants to allay those worries: “X-rays are inexpensive, and they’re easy to do, and they’re safe.” A foot X-ray generates “an extremely small amount of radiation,” she added. “So, it’s not something you should worry about getting.”
My X-ray (which cost $113, of which I paid $8.30 after insurance) revealed I had a fracture straight across the bone of my left fourth toe, with everything still aligned. Keeling recommended buddy-taping plus a boot to keep my toe immobilized; later, I graduated to a rigid-soled sandal. Someone with a joint fracture or displacement, however, would need the toe to be set and might even require surgery and a cast. Pearl is working on a splint specifically for the big toe; the pinkie toe and the big toe are the most commonly broken.
What can you do to protect your feet?
If you can avoid stubbing (or dropping something on) your toe in the first place, of course, you won’t need any of this. These experts recommended several steps we can take to protect not only our toes but also our feet in general.
First, we can wear shoes — especially when carrying or moving something — or slippers. If, like me, you don’t wear shoes indoors because of cultural tradition, Andersen said to “get yourself something that’s devoted to your house and that can be easily put on your feet.” She recommends slippers from Vionic, which have arch support, and Oofos recovery sandals. Pearl also mentioned Vionic, as well as Clarks. Nowadays, you can get all kinds of slippers with support, he said. “They go from the real fuzzy style with leopard print to just a basic black slip-on.”
Wearing shoes or slippers will help prevent other problems arising from our pandemic habits, such as calluses and heel pain from walking barefoot on hard flooring, or stress fractures and tendinitis caused by exercising without shoes. (My husband now has to wear shoes in our house because of the strain that years of going barefoot indoors and wearing flimsy flip-flops outdoors put on his feet.)
Second, take a closer look at your house and habits. Do a general walk-through, searching for clutter, cords or furniture in inappropriate spots and anything else that could pose a danger. This is a practice often recommended for older people, Keeling said, but is important now for the general population, with people spending so much extra time at home.
If there’s a place people often stub their toes, take a closer look at it and make adjustments, Andersen said. Stop careless habits, such as leaving the dishwasher door open. Install a night light, so you can see any dangerous spots if you get up in the middle of the night. Try not to rush around. “We have no place to rush to right now,” she said.
Third, consider stretching your ankles, toes and feet. This can improve both circulation, which eases recovery, and flexibility, which can help you avoid running into something and improve your reaction time. “Even if it saves two-tenths of a second in reaction time,” Pearl said, “that could be the difference between a minor sprain and a sprain with a fracture.” He lists some foot stretches and exercises on his website, arlingtonfootandankle.com.
Fourth, take care if you are missing your pedicure appointments and have decided to remove calluses from your feet yourself. Diabetics should not treat calluses themselves, Andersen and Pearl warned, and should be keeping up with their regular visits to their podiatrist to guard against foot ulcers. For non-diabetics, both podiatrists recommended staying away from razors and sticking with pumice stones or files. You can use a urea-based cream to soften calluses, and wear socks or even plastic wrap after moisturizing your feet at night to help it do its work.
Andersen said many patients who used to rely on regular pedicures to keep ingrown nails from growing back have been pleasantly surprised to learn that podiatrists can perform a surgical treatment to fix the problem permanently. They’ll say, “ ‘I have been dealing with these ingrown toenails for 40 years, and I did not know that,’ ” she said. “So that’s a good use of the pandemic.”
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