Broken Toe? (Gross picture warning)

Krieger

Barefooters
Apr 18, 2014
15
4
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Hey guys- heads-up that there are some gross toe pictures in here :) -also, sorry because I didn't know how to hide them so you had to click them to enlarge. Finally, my toenails aren't usually yellow, I just ran a 15k mud run so it is hard to get that stuff out lol

So I have been doing great since my last "issue"- learning a lot and breaking PR's left and right getting ready for my marathon in October. I do a lot of mud runs, and did a 15k yesterday in the hills of West Virginia. I "top tenned" the raced for the first time which was exciting, however I have a bit of a problem now.

Prior to the race I went back and forth on shoes- I have a new pair specifically for mud runs that I have worn about three times. The first mud run was the same distance but I noticed my toes were CRAMPED in them and really sore by the end of the race from being squished- so I took the in soles out and wore thinner socks when training in them the 2 or three times I wore them afterwards. I decided to go with them and the thinner socks for this race yesterday, in hopes that they were broken in and a little looser now.

About 4 miles into the race I noticed my right pinky toe was beginning to chaff really bad on the far right. I could tell a blister was coming on, and I had the same pain on the outside of the big toe on the same foot. I have ran with blisters before and kept pushing on. By mile 7 I was really feeling it, form went out the window. This course was incredibly rocky and a lot of high speed downhill portions running over huge rocks and thick tree roots- however I don't ever recall hitting that foot on anything or feeling anything snap or tear. In fact I do recall stubbing my left foot on a huge rock at one point but that foot is fine.

After getting the shoes and the mud off, the skin on the pinky toe looked irritated, a little red, but no major discoloration or anything. I slipped on sandals and assumed I would be treating a blister when I got home. I checked it out when I got home and it was a little purplish looking which I thought was strange but it really only hurt on the skin. I even went on a walk without shoes with my daughter that night.

This is what it looked like before bed-
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Fast forward to this morning, I can barely put weight on my right foot. I am limping around the house and can feel the toe throbbing with each heartbeat. This is what it looked like then (disgusting I know, the flash really highlighted the discoloration, it didn't look that bad until I turned the flash on.) Notice where the shoes made my toenails dig into the other toes.
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I went to the tub and rinsed it off, and poured hydrogen peroxide on the toe, preparing to lance it with a sterile needle to drain the fluid. By now I was noticing the 4th toe was somewhat swollen too. The hydrogen peroxide completely dissolved that disgusting yellow blob in the last picture, and it was agonizing. I also noticed two distinct red lines on the top of my foot following the 4th and 5th metatarsals all the way up to the front of my ankle, starting from the tops of the toes. I finished cleaning with betadine and neosporin and wrapped it in a band-aid to keep the betadine off the carpet and the dog hair out of the wound, which was actually really minor once that blister melted off.

The throbbing was gone and I felt a ton of relief over the next hour. I ended up elevating my foot and falling asleep on the couch for a few hours. When I woke up the swelling seemed better, I could bear a little more weight, and the red lines seemed to be gone on the tops of my foot though there is still some redness, just not perfectly following the lines of my metatarsals like it was. I just took a picture and you can see the right foot is still a bit swollen and there is some redness - the 4th metatarsal isn't purple like it was, but still a little swollen. Unfortunately the discoloration is a lot more evident on my phone than it is here so this probably isn't helpful, and I also didn't take the band-aid off because I am not ready to re-clean it yet but you can still see the swelling in the little toe:
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So here I am. I was planning to see a podiatrist tomorrow if the pain was worse- but I don't know what to do. I don't really want an xray because I just recently had quite a few taken for a carpal tunnel issue I am claiming with the VA and I am paranoid about that kind of stuff lol. I also don't think there is anything they can do. I don't think it requires surgery, and I don't think it is crooked enough to need a splint.

I also don't know that it is broken. I've never broken anything but I don't know what else it could be aside from infection- but I always thought a broken bone would quickly turn black/blue, and the fact that I didn't really have pain for 24 hours was strange. However, I am also not sure what else would have caused the red lines following my metatarsals on the top of my foot? I also felt no searing pain or pops, but I know you can easily get an overuse stress fracture from bad shoes/form etc.

The other thing is, I have no pain from bending, squeezing, or manipulating anything (including the 4th toe that was swollen and purple this morning, or the metatarsals beyond the toes) except in the little toe, and only in the toe itself, nothing beyond within the foot. I saw that typical RICE is a good idea, but I worry about ice- wouldn't that restrict blood flow to the area? I am also worried about compression because I don't want to have it heal crooked.

Any recommendations? Do you think I have a broken toe, or possibly 2? Is it worth booking the podiatrist tomorrow or should I just self-treat? I have a race this Saturday that I think is probably going to be scrapped, and unfortunately it was one of the ones I had been really excited about this year and had a large group going with me.

One last thing- I've always thought one of my feet was bigger than the other- but is it strange at all that the shoe did all this damage to the right foot, but nothing on the left-not even a little blister? I wonder if maybe I had a rock or something I didn't notice in the right shoe further squishing those toes together. Anyway, enough speculating on my part, please let me know your input.

Thanks again!
 
Oh, and I also just saw something about "buddy taping". Is this something I should be doing for the toe? and if so, should I be buddy taping the 3rd, 4th, and 5th toe since I don't know what the 4th is doing? Or just the 4th and 5th?
 
Looks like it could be a little infected based on the color of the blister (the fluid inside looks to not be clear) and the erythema (redness). Infections can swell. Ice won't restrict blood flow too much. Maybe try 20 minutes 3-4 time/day for a couple of day. Might help with pain and swelling. Put a towel between the ice pack and skin. Direct ice to the skin can potentially cause problems -- too cold. Nobody can really diagnose most fractures without an xray, especially a small break in a tiny toe. Worst case would be an infection and fracture but no pain with manipulation is encouraging. Maybe just a bad bruise or a small crack. Also, the redness looks to be very superficial which is encouraging too.
 
Thanks! I hadn't cleaned it well the night of the race, just soaped it up in the shower and got it bed, because it just looked like a minor blister. In hindsight I should have at least used neosporin considering the muck I was crawling in all day. I was pretty meticulous today after seeing the color and swelling, and plan to clean it good again before bed but will probably let it air out instead of using the band-aid.

I would obviously be happy about a bruise over a break so fingers crossed I guess. Any ideas on how long to stay away from running if I end up not seeing the podiatrist? Would it be okay to run if it doesn't hurt or is this one of those things I should stay off of for a specific amount of time even if it doesn't hurt?
 
  • If it were me I'd not run until it is pain free. If it is only soft tissue damage or maybe a minor infection it should only take a couple of days to feel pretty good. Photos of wound ALWAYS look worse than the wound looks in person. The main reason I thought infection is because you ran in shoes (lots of friction) in a muddy environment (lots of bacteria). The tissue damage caused by the friction makes it easier for the bacteria to set up shop. It should be very superficial and should resolve on its own without much problem. I'd keep clean and keep something over it during the day to help it stay clean. Neosporin probably won't do much, at least I don't think it does. You can let it air out during the night. Don't pick at it or bother it. You should be fine going barefoot, too, if you keep a band aid on it, just don't run until pain free. Keep an eye on it and obviously if things get worse than seek help (increased tenderness, throbbing, warm to the touch, increased redness, and so on). One good thing about infections is they become really obvious if they worsen. Hope this helps.
 
so, I showed this picture around the lab and the hospital (where I work). The consensus here is INFECTION! Go have a Dr. look at it soon! there are some nasty bugs out there, that can take hold very fast, Staphs, especially MRSA, are BAD!!! you could lose that toe or worse. Just saying...
 
The swelling looks pretty small to be a broken toe and I'm not seeing any black/blue discoloration in there either plus you didn't kick/trip on anything...I think Eldon and SI are on to it as an infection.

I've broken that same toe from kicking a rock and had to buddy tape to the 4th toe was able to run in shoes after about a week...I don't think you will be out of training for too long.
 
Thanks guys, as bad as it sounds the comments are making me a lot more optimistic! And trust me, the pictures are WAY worse, especially with the flash on. I just cleaned it again and added some pictures. I am feeling way better since getting rid of the fluid this morning. I am walking around and able to bear almost all normal weight on the foot. Still tender, but a LOT better than this morning and the swelling has gone down significantly. In fact the toe itself no longer hurts to be squeezed, unless I touch the actual blister.

If it isn't worse tomorrow I will probably not go to a doctor, no point in getting antibiotics if it is on the decline, right? I haven't had a fever or anything else weird, other than the swelling/throbbing this morning which has mostly resolved. I have been using betadine and neosporin when I clean. Should that be enough or does anyone recommend anything else?

By the way- I was not going to cut off the dead skin because I didn't want to expose it to any more bacteria- however I could see there was some dark discoloration under the skin like you see in the picture (the red stuff is betadine- sorry). I made a judgement call and cut the dead skin off to make sure there wasn't any dirt or gunk trapped under there- and there was. It looked like pieces of dirt, probably mud and stuff I picked up from the race. I cleaned it some more with hydrogen peroxide and neosporin and I am heading to bed. Thanks for the tips and advice. Hopefully I will still have a foot in the morning! :)

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Looks, pretty good! Don't worry, if it were something horrific like a worsening MRSA (Methicillin Resistant Staph Aureus, a strong bug we created with the misuse of antibiotics) infection it would look x10s worse, and quickly. MRSA can be quite destructive to tissue, especially if it gets deep into the tissue, or worse yet, into the bone. Your immune system would likely not let that happen, even if it were MRSA. People have it colonized on their bodies all the time. It really likes living in peoples' noses, I might have it and would never know, lol. I deal with wounds on a daily basis and docs rely on me for input on how to treat them, if that helps with piece of mind. Do indeed, keep it clean and covered now since the vulnerable under tissue is now exposed. The nice thing about the dead outer tissue on blisters is that they act like a bandaid themselves. The dead skin is still impervious to microbes and you know it is sound if none of the fluid inside has come out. Not that big a deal, though.

Looks good. Betadine is helpful. Don't use hydrogen peroxide. It can damage the new fragile tissue that is trying to develop. It is only good for what you used it for the other day. Cleaning the area and debreeding the dead tissue a little, however, once the healing process has kicked in stop using it.
 
Thanks! It is looking and feeling much better today. Crazy how much you realize you use something when you can't use it! I love the Mustang in your picture by the way- I have a '79 Trans Am in almost the same exact shade of blue!
 
No problem. I'm thinking about writing occasional running health related blogs, with, of course, a focus on barefoot running, so stay tuned for those. The Mustang is faster than me and I'm ok with that, lol. It is real deal old school muscle.
 
Hello Krieger - has your toe issue resolved? Did you ever go see the Podiatrist?

Please let me know if you need any tips!
 
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