When a toe is injured, the other toes become 'paralysed' and we could end up limping
Bill has always been athletic and fit. He played many sports in his younger years and, in his 30s, took up triathlons as his main sport.
The 39-year-old ran his own business, which gave him the flexibility to devote time to endurance sports events.
Last year, Bill qualified for the Ironman race held in Hawaii. But about three weeks before the race, he tripped during training and stubbed the third toe of his right foot.
An X-ray scan of his toe showed a bone fracture with a slight shift in position.
Walking was painful for Bill and trying to run even more so. This upset his plans for the upcoming race.
I fitted a tight bandage around his third and fourth toe to protect the fractured toe from too much motion. This is known as a buddy splint and is commonly used to treat less severe toe fractures.
With the splint, walking was less painful, though running remained an issue due to the higher impact on the feet.
A runner's toes have to bend upwards - known as a dorsiflex - a lot when the feet are "pushed off" the ground while running.
We discussed the situation and Bill was very disappointed that it might be better for him to skip the race. Since it was a toe fracture and not a knee or hip injury, he had not expected it to be so difficult to move around with a painful toe.
Not many people realise that our toes work as a unit. They bend up and down together when we walk.
When a single toe is injured and cannot be bent upwards, the rest of the toes become "paralysed" and we end up limping.
This results in unequal weight and force distribution between our legs, which can cause pain in other parts of the body, such as the hips and back.
Sometimes, people walk with the foot rotated to avoid putting pressure on the painful toe.
However, this can lead to foot and ankle pain as it puts a strain on the other areas of the foot.
LIMPING ON AN INJURED TOE
When Adeline limped into my consultation room, I could immediately tell that she was in great discomfort.
She is 31 and works as a bank executive. Her usual office attire includes high heels.
She had tripped over her heels and twisted her left foot. This was four months before she came to see me.
The base of the fourth toe was swollen and she was in pain.
At first, she thought it was just a sprain and sought treatment at a traditional Chinese medicine clinic.
However, the pain did not go away. After limping for four months, she started getting ankle pain and backache as well.
She consulted a physiotherapist who saw that the fourth toe was chronically swollen and sitting up higher than the rest of the toes.
This prompted Adeline to come to our clinic for a consultation.
Further tests, including a magnetic resonance imaging (MRI) scan, confirmed that the ligament below the joint at the base of the fourth toe, called the plantar plate, was completely torn.
Adeline had been walking on a dislocated toe for months.
Fortunately, a good surgical technique to repair the plantar plate is now available.
I was glad that, with the recent advances in surgical procedures for toe reconstruction, the clinic could offer her the option of surgery.
Adeline had her toe surgically repaired and is recovering well. She should hopefully be back in her heels soon.
As for Bill, he went ahead with the Ironman race and managed to complete it.
I think that both of them have since learnt the importance of caring for their toes.
•Dr Tan Ken Jin is an orthopaedic surgeon at the Orthosports Clinic at Mount Elizabeth Novena Medical Centre. He specialises in foot and ankle disorders.
A version of this article appeared in the print edition of The Straits Times on February 14, 2017, with the headline 'Broken toe woes'. Print Edition | Subscribe
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