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Dr. Rock Positano: Sausage Toe: the New Fashion Pariah

Huffington Post—December 7, 2017

"I was told that there is nothing you can do for a broken toe so I did nothing for it, so why is the toe still terribly swollen and painful two years later?” This is a common complaint from patients who have experienced firsthand the extreme pain from an injured small or lesser toe.

Lesser or small toe pain does not translate into lesser pain and disability. A colleague of mine at Yale once told me that the velocity of a toe hitting a stationary piece of furniture or the bed post is between 60-80 mph. That says it all about the so called simple toe injury.

This often results in the development of the dreaded "sausage" toe that stays swollen for months, years, even a lifetime. You can imagine what it does to a person's fashion choices. The perpetually swollen toe is often uncomfortable in dress shoes, Manolos, Jimmy Choos, walking shoes and athletic sneakers.

Patients also relate that they and their coworkers find it hard to believe that a little fractured toe can cause all this discomfort and chaos.
So why are so many people reluctant to treat a lesser toe fracture as they would any other fracture in the foot or elsewhere?

It is first and foremost important to get a foot x-ray to check for the extent, severity, and location of the lesser toe fracture. It is also advisable to perform an ultrasound examination of the forefoot to check for soft tissue, tendon, and ligament injury.

The foot and toe should be immobilized depending on the location and severity of the lesser toe fracture, swelling and of course, pain. In addition, buddy splinting the injured toe to the adjacent toe will provide additional immobilization and stability. Ice applied to the injured toe is also a good idea and is recommended to reduce the swelling in the injured toe and immediate surrounding areas.

Patients who do nothing are usually miserable, in pain and limping. They are at greater risk for developing the sausage toe. Furthermore, not treating the lesser toe fracture can often lead to traumatic arthritis later on.

So the best advice is to not ignore a lesser toe injury. Go to a foot specialist or trauma specialist to have the injury evaluated and treated aggressively. The longer you wait to treat and immobilize the toe and foot the greater the likelihood of developing a permanent swelling of the toe. Get in to see the doctor to avoid the sausage toe problem and remember there is a lot you should do when you injure your small toes.

Rock Positano, DPM, MSc, MPH, is the director of the Non-surgical Foot and Ankle Center at Hospital for Special Surgery in New York.

Read the full column at huffingtonpost.com.



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