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Toe, Foot, and Ankle Injuries

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. The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.
  • 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), physical therapy, 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?
Yes
Toe, foot, or ankle injury
No
Toe, foot, or ankle injury
How old are you?
Less than 5 years
Less than 5 years
5 years or older
5 years or older
Are you male or female?
Male
Male
Female
Female

The medical assessment of symptoms is based on the body parts you have.

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Has it been more than a month since the toe, foot, or ankle injury?
Yes
Toe, foot, or ankle injury over a month ago
No
Toe, foot, or ankle injury over a month ago
Have you had toe, foot, or ankle surgery in the past month?
If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it.
Yes
Toe, foot, or ankle surgery in the past month
No
Toe, foot, or ankle surgery in the past month
Do you think that any of your toes might have frostbite?
Yes
Cold temperature exposure
No
Cold temperature exposure
Have you had a major trauma in the past 2 to 3 hours?
Yes
Major trauma in past 2 to 3 hours
No
Major trauma in past 2 to 3 hours
Do you have severe bleeding that has not slowed down with direct pressure?
Yes
Severe bleeding
No
Severe bleeding
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Are you having trouble moving your foot or toes normally?
You may not be able to move it because of pain or swelling or because it is out of its normal position.
Yes
Difficulty moving foot
No
Difficulty moving foot
Can you move the toes, foot, and ankle at all?
Yes
Able to move the toes, foot, and ankle
No
Unable to move the toes, foot, and ankle
Have you had trouble moving the foot or toes for more than 2 days?
Yes
Difficulty moving foot for more than 2 days
No
Difficulty moving foot for more than 2 days
Is there any pain in the toes, foot, or ankle?
Yes
Pain in toes, foot, or ankle
No
Pain in toes, foot, or ankle
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
5 to 10: Moderate to severe pain
Moderate to severe pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is increasing
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is improving
Do you have any pain in your toes, foot, or ankle?
Yes
Toe, foot, or ankle pain
No
Toe, foot, or ankle pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is getting worse
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is getting better
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Is the foot or are any of the toes blue, very pale, or cold and different from the other foot or toes?
If the foot or leg is in a cast, splint, or brace, follow the instructions you got about how to loosen it.
Yes
Foot or toes are blue, very pale, or cold and different from other foot or toes
No
Foot or toes are blue, very pale, or cold and different from other foot or toes
Is any part of a toe partially or completely cut off?
Yes
Part of toe cut off
No
Part of toe cut off
Is it more than the tip of the toe or more than half the size of a dime, or can you see the bone?
Gently wash off any dirt, wrap the cut-off part in a clean cloth, put the wrapped part in a plastic bag, place the bag on ice to keep the digit cool and bring it to the hospital.
Yes
More than tip of toe severed
No
More than tip of toe severed
Is there any swelling or bruising?
Yes
Swelling or bruising
No
Swelling or bruising
Did you have swelling or bruising within 30 minutes of the injury?
Yes
Swelling or bruising within 30 minutes of injury
No
Swelling or bruising within 30 minutes of injury
Has swelling lasted for more than 2 days?
Yes
Swelling for more than 2 days
No
Swelling for more than 2 days
Do you have weakness, numbness, or tingling in your foot that has lasted more than an hour?
Weakness is being unable to use the foot or toes normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.
Yes
Weakness, numbness, or tingling for more than 1 hour
No
Weakness, numbness, or tingling for more than 1 hour
Do you suspect that the injury may have been caused by abuse?
This is a standard question that we ask in certain topics. It may not apply to you. But asking it of everyone helps us to get people the help they need.
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think the problem may be causing a fever?
Some bone and joint problems can cause a fever.
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
Is the foot trapped in something, like a jar or a toy?
Yes
Foot is trapped
No
Foot is trapped
Was an object stuck in your toe or foot?
This could be something like a nail, a needle, or a large piece of wood, metal, or plastic.
Yes
Object was embedded
No
Object was embedded
Is the object still in your foot?
Yes
Object is still embedded
No
Object is still embedded
Did the object go through a shoe or boot?
An object that has enough force behind it to go through a shoe can cause serious injury to the foot. Puncture wounds in the sole of the foot also have a high risk of infection.
Yes
Object went through a shoe or boot
No
Object went through a shoe or boot
Do you think you may need a tetanus shot?
Yes
May need tetanus shot
No
May need tetanus shot
Have you had symptoms for more than a week?
Yes
Symptoms for more than a week
No
Symptoms for more than a week

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, herbal remedies, or supplements 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.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

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 10 ft (3.1 m)[more than 5 ft (1.5 m) for children under 2 years and adults over 65].
  • A car crash in which any vehicle involved was going more than 20 miles (32 km) 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 lightheaded, 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 color 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 color 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.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

  • For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
    • You haven't had a tetanus shot in the past 5 years.
    • You don't know when your last shot was.
  • For a clean wound, you may need a shot if:
    • You have not had a tetanus shot in the past 10 years.
    • You don't know when your last shot was.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Toe, Foot, and Ankle Problems, Noninjury
Postoperative Problems
Cold Temperature Exposure

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.

  • 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 jewelry 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

Home care after breaking a toe includes applying ice, elevating the foot, and rest. Medical treatment for a broken toe depends on which toe is broken, where in the toe the break is, and the severity of the break. If you do not have diabetes or peripheral arterial disease, your toe can be "buddy-taped" to your uninjured toe next to it. Protect the skin by putting some soft padding, such as felt or foam, between your toes before you tape them together. 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, remove the tape.

In rare cases, other treatment may be needed, including:

  • Protecting the toe from additional injury. This may include using splints to stabilize the toe, a short leg cast, or a brace.
  • Surgery, if the break is severe.

Medical treatment is needed more often for a broken big toe than for the other toes. An untreated fracture 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.

  • Remove all jewelry.

    Remove rings, anklets, and any other jewelry that goes around your leg or ankle. It will be hard to remove the jewelry 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.

    Ice will reduce pain and swelling. Apply ice or cold packs right away to prevent or reduce swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.

  • 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 48 to 72 hours, if your swelling is gone, apply heat. You can start gentle exercise with the aid of moist heat to help restore and keep flexibility. Some experts advise switching between heat and cold treatments.

  • 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. The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.

  • Drain blood under a nail.

    If you have pain from blood under a nail, you can drain it to relieve the pain.

  • 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 counselor.
  • You or someone you know is a victim of 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: March 9, 2022

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine

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