DEFINITION--A painful condition of the tip of the toe (usually the first toe) caused by an exostosis (overgrowth of bone) building up under the nailbed. An exostosis occurs at the site of repeated injury, usually from direct blows. This benign overgrowth of bone can be mistaken for a bone tumor.
BODY PARTS INVOLVED
Toe (usually the big toe).
Soft tissue surrounding the exostosis, including muscles, nerves, lymph vessels, blood vessels and periosteum (covering to bone).
SIGNS & SYMPTOMS
No symptoms for mild cases.
Extreme pain at the tip of the toe and under the nail.
Tenderness over the toe.
Extreme sensitivity in the toe to pressure or minor injury.
Change in the contour of the bone, ranging from a slight lump to the appearance of a large calcified spur (1cm or more in length) in the toe. The toenail may appear distorted.
Repeated injury to the toes.
Chronic irritation to an already damaged area.
RISK INCREASES WITH
Contact sports, particularly those with quick stops and turns in which toes are repeatedly jammed into the toes of the shoes.
Ballet dancing in toe shoes.
History of bone or joint disease, such as osteomyelitis, osteomalacia or osteoporosis.
Vitamin or mineral deficiency.
If surgery or anesthesia is needed, surgical risk increases with smoking, use of mind-altering drugs, muscle relaxants, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Allow adequate recovery time for a toe injury before resuming sports participation.
Wear adequate protective equipment, especially good shoes and toe padding if necessary, for participation in sports.
Learn proper moves and techniques for your sport to minimize the risk of injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Surgery (sometimes) to remove the exostosis.
Self-care during rehabilitation.
Your own observation of signs and symptoms.
Medical history and physical exam by a doctor.
X-rays of the toes.
Overlooking a mild exostosis that produces no symptoms, despite signs of diminished performance. Athletes and coaches frequently assume that decreased performance results from loss of competitive drive or emotional causes rather than from the physical disability that actually exists.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic toe joints following repeated injury.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissue.
Impaired blood supply to the injured toe.
PROBABLE OUTCOMEToe exostosis usually causes no disability if it is treated properly. Treatment usually involves resting the injured foot and toe for 2 to 4 weeks, heat treatments, corticosteroid injections and protection against additional injury. In a few cases, surgery is necessary to remove the toenail, nailbed, exostosis and the tip of the toe.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This condition develops gradually.
Rest the injured area. Use splints or crutches if needed.
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Use proper shoes and extra toe padding, if possible, during competition and workouts to avoid recurrence of the injury.
Medicine usually is not necessary for this disorder. For minor pain, you may use non-prescription drugs such as aspirin.
If surgery is necessary, your doctor may prescribe:
Non-steroidal anti-inflammatory drugs to help control swelling.
Stronger pain relievers.
Antibiotics to fight infection.
ACTIVITYDecrease activity for 2 to 4 weeks. If surgery is necessary, resume normal activity gradually.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.
Begin daily rehabilitation exercises when movement is comfortable.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of toe exostosis.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage, or bleeding in the surgical area.
Signs of infection (headache, muscle ache, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may cause side effects.