- Reference Number: HEY-1296/2022
- Departments: Orthopaedics, Physiotherapy
- Last Updated: 1 May 2022
Introduction
This leaflet has been produced to give you general information about your injury. We understand you may not have seen a clinician face to face in fracture clinic however, most of your questions should be answered by this leaflet. If after reading it, you have any concerns or require further explanation, please do not hesitate to contact the fracture clinic team. Contact details are available at the end of this leaflet.
What is an undisplaced great toe fracture?
The x-rays you had following your injury show that you have sustained a fracture (break) in one of the bones of your big toe. It is undisplaced which means that it has not moved out of position and therefore should heal without the need for surgical intervention.
How should it be treated?
This injury can be treated simply with a firm soled shoe or a heel weight-bearing shoe until the pain settles, which is usually 3-4 weeks. You may initially require crutches but can wean off these as soon as you feel comfortable.
To manage your pain, we advise that you regularly take simple pain relief, which can be bought over the counter. If you have allergies or conditions, which prevent the use of pain-relieving or anti-inflammatory medication, please seek advice from your doctor or a pharmacist.
What should I do in the first few days?
Controlling the pain and swelling by following the principles of RICE are important:
R REST
Complete rest is not advisable. If necessary, you will be given crutches to help you take some weight off the injured toe. Exercises in the section below, can be started straight away.
I ICE
Ice will help reduce the pain in your toe and so should be applied for 10 – 15 minutes before performing any exercises. This will also help to reduce the swelling.
There are many different ways in which ice can be applied however crushed ice, in the form of frozen peas for example, is the most effective. Whichever method you choose it is important that you wrap the ice in a damp towel, in order to prevent it from ‘burning’ the skin.
Please Note:
- Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold
- Do not apply ice to an open wound
- Do not apply an ice pack to an area that has poor circulation
- When you apply ice to your skin, check the skin every five minutes and stop using it if:
- the area becomes white, blue or blotchy
- the area becomes excessively painful, numb or tingles
C COMPRESSION
If you have been given a tubigrip to wear it is important this is removed if you develop any signs of poor circulation such as tingling, numbness, blueness of the skin of the foot and increasing pain. The tubigrip should be removed when you go to bed at night, as when you are asleep you cannot monitor these symptoms.
E ELEVATION
The injured leg should be elevated above the level of the heart as much as possible, as this will reduce and prevent swelling.
Carrying out the movements of the ankle described below, while the leg is elevated, may help to reduce any swelling further.
What exercises should I do?
The simple exercises described below will help prevent stiffness developing in the ankle and foot.
1. Ankle dorsiflexion and plantar flexion
Pull your toes up towards you slowly and then point them down as far as you can.
Try to do this within your pain free range. Do not force the ankle or foot.
This range will increase as your injury heals.
2. Ankle inversion and eversion
Lie down on your back with the foot elevated so your heel does not touch anything, like on the picture opposite.
Slowly turn your foot/ankle in, then out (like a windscreen wiper), without moving the upper leg.
All photos with kind permission of ©Physiotec™
How long will the pain and swelling persist?
Pain and swelling can persist for 3 – 6 months following the injury. We advise continuing to use simple analgesia such paracetamol to help control your pain. Swelling is usually worse towards the end of the day. If this does occur, continue to use elevation as described previously.
When can I start driving again?
It is always good to check with your insurance company however, we advise it should be safe to return to driving when:
- You are no longer using a heel weight bearing shoe
- You can walk comfortably without crutches
- You can perform an emergency stop
When should I start increasing my activity?
Once you are able to walk normally, you should gradually increase your level activity. Consider trying the following exercises.
- Stand facing a chair and step backwards with your injured foot.
Keep this leg straight with your toes pointing forward and the heel on the floor.
Now bend your other knee until you feel a stretch in the calf of your injured side. Hold this for 30 seconds and repeat three times per day.
2. From the position in exercise 1 move your injured foot forward but keep it slightly behind your other leg.
Ensure that your toes point forward and bend both knees, keeping the heel of your injured foot on the floor.
You should feel a stretch in the calf of your injured side. Hold for 30 seconds and repeat three times per day.
3. Stand holding on to a chair, spread your weight equally over both feet and push up onto your toes as high as possible.
Hold for five seconds and slowly lower. Repeat 10 times, twice per day.
Once this becomes easier you can increase the number of repetitions or progress to repeating this stood on the injured leg on its own.
4. Stand on your injured leg and balance for as long as possible. To begin with, you may need to hold on to something solid to prevent you falling over.
As you improve, try doing functional activities such as washing the dishes or cleaning your teeth while you are standing on the one leg.
Try to hold your balance for up to 30 seconds.
All photos with kind permission of ©Physiotec™
If you participate in an active hobby then it is advisable that you do not return to this until you have full strength, full range of movement and you can walk briskly without experiencing pain and swelling.
If you play a sport, you can practice sports specific activities; like dribbling or jumping. Build up these exercises gradually from around 6 weeks, in order to help regain strength and flexibility, before returning to full training sessions and competition.
Do I require a follow up?
Do I need to be referred to Physiotherapy?
If the fracture clinic team feel you need to be seen by the Physiotherapy team, you will be directly referred to physiotherapy from fracture clinic and if this is the case, you will have been informed of this in your telephone call following your Virtual Fracture Clinic appointment. You will receive a letter or phone call to book this appointment within 2 weeks of the referral being made.
If you have not received one within this time, please contact the physiotherapy department on 01482 674880 between the hours 8.00am – 4.00pm Monday to Friday. If there is no answer please leave a message and your call will be returned with the same working day.
Most of the time however, a referral to Physiotherapy is not needed, but if you have any concerns, are unable to follow the advice in this leaflet, or if you still have reduced movement, strength or function, East Riding GP patients can contact the East Riding MSK Physiotherapy service on 01377 208300. Alternatively you can complete a self referral form on https://www.chcpmsk.org.uk/self-referral-form-introduction
Hull GP patients should call the fracture clinic number in the information below.
Do I need a Fracture Clinic follow up appointment?
A follow up appointment for fracture clinic is not required and you have been placed on a Patient Initiated Follow Up (PIFU) pathway. This means you will not have another appointment to be seen in fracture clinic.
If, however you have any problems or further queries relating to this injury within the next six weeks, you can contact us on 01482 674378 during clinic hours 9.00am – 4.30pm Monday to Friday. Please do not choose an option and when prompted leave a message if there is no answer and we will aim to get back to you within the same working day. If you have not needed to contact us in the six weeks after your injury, you will be discharged and should seek advice from your GP.
This leaflet was produced by the Orthopaedic Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in May 2025
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
