Sand Toe Pain

Holiday weekends are always a great time for many families. It is a chance to go somewhere and explore, may catch up with friends or relatives at a favorite location spot. In our office, the week after holidays is just as exciting. There are always plenty of fun and exciting "how I hurt myself" stories.

Recently a friend came in after their family weekend in Mexico. (As a side note, Mexican holiday weekends usually produce better stories. It usually means there will be two to three moments of "maybe I shouldn't have... But I did anyway.")

John met his two brother's families in Mexico for a weekend. Their kids are about the same age and getting old enough to travel. Halfway through the vacation a challenge was made by the teenage boys against their dads. Kids vs. dads, sounded like a great family time. Unfortunately, the kids won the first game easily, and the second game even easier. The teenagers started trash talking after the first game and it became worse during the second.

John and his brothers decided they were going to win the next game. They didn't want to listen to teenagers talk about how old their parents were getting all weekend. There was a little pride mixed with "lets show them."

To make a long story short, the teenagers walked away with a loss. John walked away with a broken finger and a big toe he couldn't walk on. His brother Mike had to pretend his back didn't hurt the rest of the weekend. Most importantly, the kids didn't win. All injuries were acceptable since they achieved their goal of winning.

John already had the finger in a splint. He had dislocated the finger before and quickly new how to pop it back in. We sent him out for x-rays just to make sure there was not anymore underlying damage. The x-rays came back negative and the finger was an afterthought in a few weeks.

The toe was a different story. It was swollen and very tender. It hurt to walk, bend, or stand on. Anytime he placed pressure on the toe he felt a sharp stabbing pain. Thankfully the x-rays were also negative for fracture, but he had a very severe case of sand toe, or sprain of the big toe.

Sand toe is similar to turf toe. They are both injuries of the soft tissue around the big toe. Muscles, tendons, and ligaments cross the joint to support it. The joint capsule is very tough and strong. However, in some circumstances the toe can be bent too far in a direction.

Turf toe tends to happen in sports like football, where the toe is extended and then bent too far toward your ankle. This excessive extension sprains the ligaments and joint. Click here for more on Turf Toe.

Sand toe occurs when the toe is bent the other direction. The toe is flexed toward the ball of your foot and it gets bent even further. The excessive flexion sprains the ligaments, tendons, and joints on the other side of the toe.

Sprains to the big toe always are slow to resolve. When you walk your body weight crosses the big toe with every step. People never realize how important their big toe is to walking, standing, running, or jumping until they hurt it. Even after most of the pain is gone, there will still be reminder twinges of pain weeks down the road.

John began treatment with goals to decrease pain and swelling. He started taking NSAIDs immediately (which he had already discussed with his Doctor from previous injuries). Unfortunately he didn't start icing his toe until he came home. John knew that he should, but did not want the kids to see.

Ice will be his best friend. He was to start icing as much as he could during the day for 15 minutes and then take it off for 15 minutes. He was to repeat the cycle as many times a day as he could. Three times a day is ok, five is better, and ten is fantastic. Home icing is very important because in office treatment is limited.

Electric therapy can be performed but is difficult because of the size and shape of the toe. It helps more in moderate or severe cases to decrease the pain. Ultrasound and cold laser therapy help too. Cold laser does an excellent job at decreasing the inflammation and pain. It increases blood flow to the toe to speed healing. It triggers metabolic reactions to increase energy for repair mechanisms. It also turns on the cell repair mechanisms to further speed the recovery. Cold laser therapy is an excellent treatment option, read more about Cold Laser Treatments

John quickly found that several supportive shoes felt better than others. Flip flops were very uncomfortable and more painful to walk in.

He was reminded that most injuries respond better to P.R.I.C.E; Protect, Rest, Ice, Compress, and Elevate. It was advice that he will try and utilize next time because the boys are only getting bigger.