Toe Injury

When To Call

Go to ER Now

• Bleeding that won't stop after 10 minutes of direct pressure

Call Doctor or Seek Care Now

• Skin is split open or gaping and may need stitches
• Large swelling is present
• Blood under a nail is causing more than mild pain
• Nail is torn
• Base of nail has popped out from under the skin fold
• Dirt in the wound is not gone after 15 minutes of scrubbing
• Skin or nail is cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• Severe pain and not better 2 hours after taking pain medicine
• Age less than 1 year old
• Age less than 2 years and toe tourniquet suspected. (Hair wrapped around toe, groove, swollen red or bluish toe)
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Broken toe suspected
• Toe injury that causes bad limp
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Pain not better after 3 days
• Not using the toe normally after 2 weeks
• You have other questions or concerns

Self Care at Home

• Minor toe injury

Care Advice

What You Should Know About Toe Injuries:

• There are many ways that children can hurt their toes.
• There are also many types of toe injuries.
• You can treat minor toe injuries at home.
• Here is some care advice that should help.

Pain Medicine:

• To help with the pain, give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Use as needed.

Bruised/Swollen Toe:

• Soak in cold water for 20 minutes.
• Repeat as needed.

Small Cuts or Scratches:

• For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press down firmly on the place that is bleeding for 10 minutes. This is the best way to stop bleeding. Keep using pressure until the bleeding stops.
• Wash the wound with soap and water for 5 minutes.
• For any dirt in the wound, scrub gently.
• For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
• Cover it with a bandage. Change daily.

Jammed Toe:

• Caution: be certain range of motion is normal. Your child should be able to bend and straighten each toe. If movement is limited, your doctor must check for a broken bone.
• Soak the foot in cold water for 20 minutes.
• If the pain is more than mild, "buddy-tape" it to the next toe.

Smashed or Crushed Toe:

• Wash the toe with soap and water for 5 minutes.
• For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
• Cover it with a bandage. Change daily.

Torn Nail (from catching it on something):

• For a cracked nail without rough edges, leave it alone.
• For a large flap of nail that's almost torn through, cut it off. Use a pair of scissors that have been cleaned. Cut along the line of the tear. Reason: pieces of nail taped in place will catch on objects.
• Soak the toe for 20 minutes in cold water for pain relief.
• Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then cover with a bandage. Change daily.
• After about 7 days, the nailbed should be covered by new skin. It should no longer hurt. A new nail will grow in over 6 to 8 weeks.

Remove Ring:

• Remove any ring that is on an injured toe.
• Reason: swelling may occur.

Shoes to Reduce Pain:

• If regular shoes cause too much pain, make a change in footwear.
• Wear a shoe with a firm sole to limit motion. Reason: injured toes hurt when they bend (are flexed).
• If the top of the shoe increases pain, wear an open-toe sandal. Another option is to use an old sneaker. Then cut out the part over the toe.

Buddy-taping:

• Buddy-taping is taping the injured toe to the one next to it.
• Method: gauze padding must be placed between the toes before taping them together.
• How long to buddy tape: usually needed for 1 - 2 weeks. By then new bone formation will close the break. Then pain with movement will be reduced.
• Usefulness: buddy-taping is optional. Sometimes, it makes the pain worse. Wearing the right shoe is much more helpful.

Call Your Doctor If:

• Pain becomes severe
• Pain not better after 3 days
• Toe not normal after 2 weeks
• You think your child needs to be seen
• Your child becomes worse

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Photos

FIRST AID Advice - Bleeding Wound of the Toe

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.