What is a sprained toe?
A sprained toe is the medical term used when the ligaments of the toe (phalanges) have been injured by being overstretched or torn. The foot itself is made of three sections of bones. The bones at the back of the foot under the ankle joint are known as the tarsal bones which include the calcaneus (which forms your heel), the talus (which forms part of the ankle), Navicular, Cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the five long metatarsal bones. The metatarsals connect at the back to the cuneiforms and cuboid bones and at the front to the toes. The toes are the last section consisting of five bones numbered in the sense that your big toe is first and your little toe is your fifth. The toes are called phalanges which like the fingers are individually divided into three parts; there is a distal section (the section under your nail), a middle section and a proximal section (the section that connects to the metatarsals) and the big toe is referred to as the hallux.
The three joints of a toe are made up of strong capsules that form around each joint enclosing it and preventing either boney ends of the interconnecting bones from impacting. The first joint is known as the metatarsal-phalangeal joint (the joint that connects the metatarsals to the phalanges), the second joint that connects the proximal phalangeal bone to the middle phalangeal bone is called the proximal interphalangeal joint (pip joint) and the last joint is the distal interphalangeal joint (dip joint) connecting the distal and middle bones. The big toe differs from the rest by only having two interconnecting joints as it is missing the proximal interphalangeal joint. The formation of the joints allows a wide range of movement in flexion and extension and also allows you to curl your toes. Each joint capsule is filled with a small amount of thick fluid called synovial fluid which acts like a cushion and there is protective layer of articular cartilage that covers each boney surface. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments that surround the joint are made of thick, tough, fibrous tissue; they overlap the joint and work in co-ordination with the attaching muscles to provide protection and stability for the toe.
What is the difference between a sprained toe and a strained toe?
Sprain injuries are commonly confused with strains. The injury is very similar but a strain only affects the muscles and tendons not the ligaments.
Why and when does a sprained toe happen?
Toe sprains are a common injury and effect people of all ages; normally the result of stubbing your foot or kicking something awkwardly. It can occur during sports, for example from football tackles or from dancing especially ballet where there is a lot of repetitive stress and pressure endured when balancing on the tips of your toes. In fact any activity where the toe hyper-flexes or hyper-extends into an abnormal position with your body weight behind it can result in a sprained toe. There are some risk factors that may leave you more prone to suffering from a sprained toe, such as wearing inappropriate footwear that doesn’t support or protect the toes.
Due to the nature and symptoms of the injury most severe sprains are hard to distinguish between strains or mild fractures which can also cause damage to the surrounding ligaments. The severity of the damage done to a ligament varies, overstretching can cause small tears in the ligament itself or with more traumatic sprains partial or complete tears can occur. The overstretching and tears cause high levels of inflammation to gather around the ligament and joint causing the huge levels of swelling you notice after the injury. The swelling is normally accompanied by a considerable amount of bruising caused by bleeding from the ligament and joint. All sprains are graded by their severity:
Grade I - Mild sprain where stretching of the ligament causes small tears but the joint remains fully functional and stable.
Grade II – Moderate sprain where a partial tear of the ligament occurs but the joint remains fully functional and only mildly unstable.
Grade III – Severe sprain that causes a complete tear of the ligament resulting in a loss of joint function and instability.
What does a sprained toe feel like?
A sprained toe causes an intense, immediate, sharp pain around the site of the sprained ligament. This pain can radiate up into the front of the foot, down into the sole of the foot and occasionally into the ankle. In some cases a tearing or snapping noise is heard during the injury. The sprain will be accompanied by swelling and bruising that will be incredibly tender to touch. In severe grade 3 cases there will possibly be visible joint deformity. Pain levels will be aggravated by any toe movements making weight bearing and walking very painful. In some milder sprain cases such as a grade 1, patients can still fully use their toes with only slight stiffness and a feeling of discomfort on weight bearing resulting in a very mild limp. The intense pain that some patients experience after a sprain will last for several hours which will be aggravated or prolonged by any walking or examination.
What to do if a sprained toe is suspected?
Your actions immediately after a sprain can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol. This involves: Protection for the toe by either strapping it or using an elastic bandage like a tubi-grip. Rest your foot, try not to walk about on it too much and if you have to then ensure you are wearing shoes that aren’t too tight over the toes but that still provide the toes with protection. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the ice pack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and ensure you take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
You should also follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days, after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating movements should be avoided in case of further injury. Massage or manipulation should be avoided over the first three days after injury as it will also increase any bleeding and swelling.
How long does a sprained toe take to heal?
A mild toe sprain can recover in as little as one to two weeks, more moderate or severe toe sprains take longer, however most sprains have fully healed within six weeks. If you experience pain longer than six weeks it is advisable to attend your GP.
How will a sprained toe be diagnosed?
Your GP or Therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis unless a fracture is suspected.
What treatment options are available for a sprained toe?
Your GP will most likely prescribe anti-inflammatory medication to reduce any swellingand painkillers for pain relief. You will be advised to follow the P.R.I.C.E and H.A.R.M protocols outlined above. A sprained toe can take anything from 4-6 weeks to heal, if not longer for more severe sprain. Your GP or therapist will be able to provide you with exercises to strengthen ankle ligaments and muscles to aid the healing process and prevent reoccurring injury. Many people find manipulative therapies such as physiotherapy, chiropractic and osteopathy help through mobilisation treatment of the toe and foot as it works to reduce the severe stiffness levels and return the joint back to its normal movement. More severe sprains that result in complete tears and joint instability may need a cast or splint, in most instances this will be enough to aid the healing process.