Toe, Foot, and Ankle Injuries

Home Treatment

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. However, if you suspect you may have a more severe injury, use first aid measures while you arrange for an evaluation by your doctor.

First aid for a suspected broken bone

• If a bone is sticking out of your skin, do not try to push it back into your skin. It is better to leave the bone alone and cover the area with a clean bandage.
• It is important to control bleeding from your injury.
• Be sure to remove all anklets or rings immediately. It may be difficult to remove the jewellery once swelling occurs, which in turn can cause other serious problems, such as nerve compression or restricted blood flow. See an illustration of removing a ring that is stuck.
• Try to free your trapped toe or foot if it is stuck in an object, such as a pipe, toy, or jar.
• Splint your injured area without trying to straighten your injured limb. Loosen the wrap around the splint if you develop signs that indicate the wrap is too tight, such as numbness, tingling, increased pain, swelling, or cool skin below the wrap. A problem called compartment syndrome can develop.

If a cast or splint is applied, it is important to keep it dry and to try to move the uninjured part of your extremity as normally as possible to help maintain muscle strength and tone. Your doctor will give you instructions on how to care for your cast or splint.

Home treatment for a sore or sprained toe

• Use rest, ice, compression, and elevation (RICE) for pain and swelling.
• If you do not think your toe is broken and you do not have diabetes or peripheral arterial disease, your sore or sprained 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. Do not buddy-tape a broken toe unless your doctor tells you to.

Home treatment for a minor foot or ankle injury

If you have a minor injury, try home treatment measures to relieve pain, swelling, and stiffness.

• Be sure to remove all rings, anklets, or any other jewellery that goes around a leg or ankle. It will be more difficult to remove the jewellery later if swelling increases.
• Use rest, ice, compression, and elevation (RICE) to relieve pain and swelling. See an illustration of how to wrap an ankle.
• Walk or bear weight on your affected foot as long as it is not painful. If it is painful and pain continues, evaluate your symptoms again, using the Check Your Symptoms questions in this topic.
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage your injured area if it causes pain.
• For the first 48 hours after your injury, avoid things that might increase swelling in the injured area, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
• After 48 to 72 hours, if your swelling is gone, apply heat and begin gentle exercise to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments (contrast baths).
• Start exercises using the MSA process (gentle exercise). MSA stands for movement, strength, and alternate activities.
  • Movement. Resume a full range of motion as soon as possible after an injury. After 24 to 48 hours of rest, begin moving the injured area. Stop any activity if it causes pain and give the injured area more rest. Gentle stretching will prevent scar tissue formation that may decrease movement.
  • Strength. Once the swelling is gone and range of motion is restored, begin gradual efforts to strengthen the injured area.
  • Alternate activities. After the first few days but while the injury is still healing, phase in regular exercise using activities or sports that do not place a strain on the injured area. If certain activities cause pain, stop doing those activities but continue doing your other exercises.

Range-of-motion exercises

Begin gentle range-of-motion exercises right after your injury while you have ice on your ankle. Perform a set of exercises by repeating them 10 to 30 times. Do each set 3 to 5 times a day.

Try the following simple range-of-motion exercises:

• Trace the alphabet with your toe, encouraging ankle movement in all directions.
• Sit in a chair with your foot flat on the floor. Slowly move your knee from side to side while keeping your foot pressed flat.

Towel curls. While sitting, place a hand towel on a smooth floor, such as wood or tile. While keeping your heel on the ground, curl your toes and grab the towel with your toes to scrunch the towel. Let go, and continue scrunching up the entire length of the towel. When you reach the end of the towel, reverse the action by grabbing the towel with your toes, scrunching it, and pushing it away from you. Repeat the exercise until you have pushed the entire length of the towel away from you.

Stretching exercises

About 48 to 72 hours after your injury, start exercises to stretch your Achilles tendon, which connects the calf muscles on the back of the lower leg to the bone at the base of the heel.

Towel stretch. If you cannot stand, sit with your knee straight and a towel looped around the ball of your foot. Gently and slowly pull back on the towel for about 15 seconds until you feel your calf stretch. In moderate to severe ankle sprains, at first it may be too painful to pull your toes far enough to feel a stretch in your calf. Use caution, and let pain be your guide. A little pain is normal, but you should not feel moderate to severe pain. Repeat this exercise about 15 to 20 repetitions daily for about a week. Then, make Achilles stretches part of your daily routine to maintain flexibility.

Calf stretch. If you are able to stand, you can do this exercise by facing a wall with your hands at shoulder level on the wall. Place your injured foot behind the other with the toes pointing forward. Keep your heels down and your back leg straight. Slowly bend your front knee until you feel the calf stretch in the back leg. Repeat as above.

Strengthening exercises

Once you can bear weight without increased pain or swelling, begin muscle-strengthening exercises. These exercises should be held for 3 to 5 seconds. Do 15 to 20 repetitions once or twice daily for 2 to 4 weeks, depending on the severity of your injury.

Start by sitting with your foot flat on the floor and pushing it outward against an immovable object such as a wall or heavy furniture. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance.

While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot.

Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot.

Balance and control exercises

When you are able to stand without pain, you can begin balance and control exercises. You can start by standing in a doorway and lightly holding on to the doorjamb. When you can do this for 60 seconds, try adding the advanced moves in the next level.

Stand on your injured foot only and hold your arms:

• Out to the side with your eyes open.
• Across your chest with your eyes open.
• Out to the side and close your eyes.
• Across your chest and close your eyes.

Do six repetitions, holding each for 60 seconds, once a day.

Take good care of your feet

• Wear supportive footwear to prevent reinjuring your foot or ankle.
• Wear roomy footwear, especially if the front of your foot hurts.
• Consider using an orthotic shoe device, such as an arch support, to help relieve foot pain.
• Treat blisters to prevent an infection.

Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Medicine you can buy without a prescription

Try a non-prescription medicine to help treat your pain:
Acetaminophen, such as Tylenol or Panadol Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) ASA (also a non-steroidal anti-inflammatory drug), such as Aspirin or Bufferin

Safety tips

Be sure to follow these safety tips when you use a non-prescription medicine:

Carefully read and follow all directions on the medicine bottle and box. Do not take more than the recommended dose. Do not take a medicine if you have had an allergic reaction to it in the past. If you have been told to avoid a medicine, call your doctor before you take it. If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to. Do not give ASA to anyone younger than age 20 unless your doctor tells you to.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• Numbness, tingling, or cool, pale skin develops.
• Symptoms do not improve with home treatment.
• Symptoms become more severe or more frequent.

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Author:	Jan Nissl, RN, BS	Last Updated: March 29, 2007
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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