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Toe, Foot, and Ankle Injuries

Swelling and bruising of the ankle, Opens dialog

Puncture Wound, Opens dialog

Ankle with ligament tear, Opens dialog

Achilles tendon, Opens dialog

Stress fracture of the foot, Opens dialog

How to stop bleeding from a skin wound, Opens dialog

Removing a Ring From a Finger or Toe, Opens dialog

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Overview

Everyone has had a minor toe, foot, or ankle injury that caused pain or swelling. Most of the time our body movements don't cause problems. But sometimes symptoms develop from everyday wear and tear, overuse, or an injury.

Toe, foot, or ankle injuries most often occur during:

Sports or recreational activities.
Work-related tasks.
Work or projects around the home.

In children, most toe, foot, or ankle injuries occur during sports, play, or falls. The risk for injury is higher in sports with jumping, such as basketball. And it's higher in sports with quick direction change, such as soccer or football. Any bone injury near a joint may injure the growth plate (physis) in a child. It needs to be checked.

Certain athletes, such as dancers, gymnasts, and soccer or basketball players, have a higher risk of toe, foot, or ankle injuries.

Older adults are at higher risk for injuries and fractures. That's because they lose muscle mass and bone strength as they age. They also have more problems with vision and balance. These problems increase their risk of injury.

Most minor injuries will heal on their own. Home treatment is usually all that's needed.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, or a fall. It can also happen if you twist, jerk, jam, or bend a limb abnormally. Your pain may be sudden and severe. Bruising and swelling may start soon after your injury. Acute injuries include:

Bruises (contusions). After an ankle injury, bruising may extend to your toes from the effects of gravity.
Puncture wounds. Sharp objects such as nails, tacks, ice picks, knives, teeth, and needles can all cause puncture wounds. These wounds increase your risk of infection because they are hard to clean. They also provide a warm, moist place for bacteria to grow.
Injuries to ligaments that support your joints.
Injuries to tendons, such as ruptured tendons in your heel (Achilles tendon). Children ages 8 to 14 may have a condition known as Sever's disease. It causes injury to the growing bone where the Achilles tendon is attached. This usually occurs during activity and is relieved with home treatment.
Injuries to your joints (sprains). If a sprain doesn't seem to be healing, you may have a condition called osteochondritis dissecans (OCD). It causes lasting symptoms. In OCD, a piece of bone or cartilage (or both) inside a joint loses blood supply and dies. Symptoms include pain and swelling.
Pulled muscles (strains). Muscles of the foot and ankle can be strained. They can also rupture.
Broken bones (fractures), such as a broken toe.
A bone moving out of place (dislocation).
A crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on your joint or other tissue. It often happens when a person "overdoes" an activity or repeats the same activity over and over. Overuse injuries include:

Retrocalcaneal bursitis, which is inflammation of the bursa. It causes swelling and tenderness of the back of the heel and ankle. Pain usually gets worse while you are wearing shoes and during activity. Pain improves during rest.
Achilles tendinitis or tendinosis (tendinopathy). This is the breakdown of soft tissues in and around the Achilles tendon, which connects the calf muscles to the heel bone.
Stress fracture. This is a hairline crack in a bone.
Plantar fasciitis. This is inflammation of the plantar fascia, a broad, flat ligament on the bottom of the foot. This ligament extends from the front of the heel to the base of the toes. It helps maintain the arch of the foot.
Metatarsalgia, which is pain in the front (ball) of the foot.

Treatment

Treatment for your toe, foot, or ankle injury may include first aid (such as using a brace, splint, or cast), a special shoe (orthotic device), physiotherapy, or medicine. In some cases, surgery is needed. Treatment depends on:

The location and type of injury, and how bad it is.
When the injury occurred.
Your age, your overall health, and your activities (such as work, sports, or hobbies).

Check Your Symptoms

Do you have a toe, foot, or ankle injury? Review health risks that may make any symptom more serious.

Yes

Toe, foot, or ankle injury

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Major trauma is any event that can cause very serious injury, such as:

A fall from more than 3.1 m (10 ft)[more than 1.5 m (5 ft) for children under 2 years and adults over 65].
A car crash in which any vehicle involved was going more than 32 km (20 miles) per hour.
Any event that causes severe bleeding that you cannot control.
Any event forceful enough to badly break a large bone (like an arm bone or leg bone).

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or light-headed, like you may pass out.
Feeling very weak or having trouble standing.
Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Being very sleepy or hard to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
Acting confused. The child may not know where he or she is.

With severe bleeding, any of these may be true:

Blood is pumping from the wound.
The bleeding does not stop or slow down with pressure.
Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

The bleeding slows or stops with pressure but starts again if you remove the pressure.
The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

The bleeding stops on its own or with pressure.
The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.

There are other reasons for colour and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal colour returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.

Symptoms of infection may include:

Increased pain, swelling, warmth, or redness in or around the area.
Red streaks leading from the area.
Pus draining from the area.
A fever.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.

Usually found in dirt and soil, tetanus bacteria typically enter the body through a wound. Wounds may include a bite, a cut, a puncture, a burn, a scrape, insect bites, or any injury that may cause broken skin. Tetanus can also happen with other infections, like dental infections. It can happen during a surgery or pregnancy and delivery.

A wound can be so small, you may not notice you have one. Or a skin blister could break and become an open wound. If there is any delay in finding or cleaning a wound, there is an increased risk for skin infection and a chance for tetanus to get in the wound. A tetanus infection can start 3 to 21 days after the bacteria enter the wound. Be especially careful about wounds on your fingers and toes.

Many people may not know when they got their last tetanus shot. So it's a good idea to call your doctor to see if you need one.

Make sure to stay up to date on your tetanus shots. A tetanus shot is recommended:

For a dirty wound that has things like dirt, saliva, or feces in it, if you haven't had a tetanus shot in the past 5 years.
For a clean wound, if you haven't had a tetanus shot in the past 10 years.

Toe, Foot, and Ankle Problems, Non-Injury

Post-Operative Problems

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Self-Care

First aid for a possible broken bone

Most minor toe, foot, or ankle injuries will heal on their own. Home treatment is usually all that's needed. But if you think that you might have a more severe injury, use first aid until you can be seen by a doctor.

Clean a skin wound as soon as you can. This will help prevent infection, scarring, and tattooing of the skin from dirt left in the wound.
If a bone is sticking out of your skin, don't try to push it back into your skin. It's better to leave the bone alone. Cover the area with a clean bandage.
Control bleeding with direct pressure to the wound.
Remove all anklets or rings right away. It may be hard to remove the jewellery after swelling starts. This can then cause other serious problems, such as a compressed nerve or restricted blood flow.
Try to free your trapped toe or foot if it's stuck in an object, such as a pipe, toy, or jar. Don't try to force it out, because that could cause more swelling.

Treating a broken toe

Some broken toes can be cared for at home. Try using ice, elevating the foot, and resting.

Treatment depends on which toe is broken, where in the toe the break is, and how bad the break is. Medical treatment is needed more often for a broken big toe than for the other toes. If you don't have diabetes or peripheral arterial disease, your toe can be buddy-taped to the healthy toe next to it. Put some soft padding, such as felt or foam, between your toes before you tape them together. This helps protect the skin. Your injured toe may need to be buddy-taped for 2 to 4 weeks to heal. If your injured toe hurts more after buddy taping it, take the tape off.

Other treatment may be needed. Your doctor may recommend:

Wearing a splint or cast to keep the toe stable and help it heal.
Surgery. This may be an option for a bad break.

A fracture that isn't treated may cause long-term pain, limited movement, and deformity.

Caring for a minor foot or ankle injury

Try the following tips to help relieve foot or ankle pain, swelling, and stiffness.

Clean a skin wound as soon as you can.
This will help prevent infection, scarring, and tattooing of the skin from dirt left in the wound.
Check your feet every day.
Take a look at your feet to see if you have pressure spots, redness, or blisters.
Remove all jewellery.
Remove rings, anklets, and any other jewellery that goes around your leg or ankle. It will be hard to remove the jewellery after swelling starts.
Rest.
It's important to rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
Use ice.
Put ice or a cold pack on the affected area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake).
Wrap the injured or sore area.
Compression, or wrapping the area with an elastic bandage (such as an Ace wrap), will help reduce swelling. Don't wrap it too tightly, because that can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, and swelling in the area below the bandage.
Elevate the injured or sore area.
Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the area on pillows while you apply ice and anytime you sit or lie down.
Avoid more swelling.
For the first 48 hours after your injury, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.
Apply heat.
- After 2 or 3 days, you can try applying heat to the area that hurts. Types of heat therapy include microwavable packs and disposable heating patches.
- Apply heat for 10 to 20 minutes at a time.
- You might also try switching between cold and heat.
Walk on your affected foot.
Walk or bear weight on your affected foot as long as it isn't painful.
Rub the area.
Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the injured area if it causes pain.
Start exercises.
Ask your doctor about exercises using the MSA process (gentle exercise). MSA stands for movement, strength, and alternate activities.
Don't smoke or use other tobacco products.
Smoking slows healing because it decreases blood supply and delays tissue repair.

If you need to use a wrap for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.

Signs of possible abuse

Most injuries are not caused by abuse. But bruises are often the first sign of possible abuse. Suspect physical abuse of a child or vulnerable adult when:

Any injury cannot be explained or does not match the explanation.
Repeated injuries occur.
Explanations change for how the injury happened.

You may be able to prevent further injuries by reporting abuse. Seek help if:

You suspect child abuse or elder abuse. Call your local child or adult protective agency, police, or a health professional, such as a doctor, nurse, or counsellor.
You or someone you know is experiencing intimate partner violence (IPV).
You have trouble controlling your anger with a child or other person in your care.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

New or worse pain or swelling.
New signs of infection, such as redness, warmth, pus, or a fever.
New or worse numbness, tingling, or cool and pale skin.
Movement or strength decreases.
Symptoms occur more often or are more severe.

Learn more

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Credits

Current as of: July 31, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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