OpenHealth Q&A

Should I Seek Treatment for My Big Toe’s Malunion?

**Personal Background:** - 23 years old, male - Height: 6 feet - Weight: Fluctuates between 200 and 205 lbs - Currently on 30mg generic Vyvanse for ADHD - Infrequent alcohol consumer - Uses nicotine pouches regularly; previously a smoker/vaper - Resides in Canada **My Issue/Inquiry:** Greetings everyone! A few years back, in 2021, I suffered a fracture to my **left big toe** after landing directly on it while attempting a calisthenics maneuver (not one of my smarter moments!). Initially, I couldn’t determine whether it was a fracture or a severe sprain. In a lapse of judgment, I opted to buddy-tape it to my adjacent toe, thinking it was just a sprain. I avoided placing any weight on it for several weeks, shifting my balance to the ball of my foot instead. As time passed, the discomfort diminished, enabling me to gradually add weight and resume my regular workout routine, all the while ensuring I maintained the buddy tape. Looking back, I realize I returned to exercising too soon, and the strain from my cardio and weight training likely hindered my recovery. Approximately **9-10 weeks post-injury**, I eventually sought medical attention at a walk-in clinic for an x-ray. By that stage, I was walking almost normally, with discomfort primarily occurring when attempting to bend the toe. Thankfully, the pain had reduced significantly by then, about 80%. I had three x-rays taken to assess the issue. The physician informed me that the toe had healed improperly, a situation he attributed to my prolonged use of buddy taping. When I inquired about the possibility of surgery to realign the bone, he asked whether I experienced ongoing pain or issues with mobility. I mentioned some mild pain when bending the toe but that otherwise, I was managing fine—walking was not a problem, though I could only bend it about 65% compared to my uninjured right big toe. He concluded that since my pain had improved and my walking capabilities were intact, surgical intervention was not necessary at that moment. He did advise against continuing to buddy-tape. I followed his guidance and let it be. Now, looking at the present situation, my big toe is completely pain-free. However, it’s evident that the bone didn’t heal correctly. I gained some range in bending it—now around 85-90% of the flexibility of my uninjured toe. While the limited bend isn’t troublesome since I don’t use my toes to grip or pick things up, it does occasionally feel stiff. Sometimes, the toe seems to twitch when I attempt to bend it normally, feeling weaker than my other big toe. In those instances, I simply crack the knuckle and stretch it, alleviating the tightness for days or even weeks. I have no difficulties with walking, running, jumping, or any climbing activities. If I knew that my toe's current state would remain stable without worsening, I wouldn't bother seeking correction and would leave it as is. However, I’m concerned that it may lead to more serious problems later, like arthritis. If that’s a potential risk, it may be wise to address it now, as my body is more capable of healing at this age compared to later in life. **I’m seeking advice: do you think there’s a risk of developing more serious issues like arthritis in the future, or is it likely to remain as it is?** I haven’t sought a second opinion since my doctor visit in 2021. **Additional Context:** Here are the x-ray findings from my doctor’s visit: "There is a comminuted fracture at the distal aspect of the proximal phalanx of the big toe with accompanying soft tissue swelling. Mild volar angulation of the distal fragment is noted." I intended to share some photos of my toe from various angles, both bent and straight, for reference, to give you a clearer understanding of my situation. Thanks for taking the time to read my concerns!

Answers (1)

3/17/2025, 9:00:51 PM

OpenHealth AI

It's great that you're actively seeking to understand your toe's condition and possible future implications. Based on your description, while your toe seems to have healed well enough for most activities, there are indeed some considerations worth discussing regarding the potential for future complications and improvement.

Key Points:

1. Current Condition: Your big toe has healed in a malaligned state, which may not cause issues now but could predispose you to further problems later, such as arthritis.
2. Potential Risks: Misalignment may lead to joint wear and increased stiffness over time, raising the risk of arthritis.
3. Next Steps: Consider evaluating your toe's function and discussing options with a healthcare provider specializing in foot and ankle injuries.

Explanation:

From what you've shared, it sounds like you did a commendable job in rehabilitation initially, and it’s reassuring that you're experiencing minimal pain and maintaining functionality. Given your age, your body is generally more resilient and capable of healing, so addressing your concerns sooner rather than later is wise.

Regarding arthritis, malunion—especially in areas like the toe—can lead to uneven pressure across your joint when walking or exercising. This uneven pressure might accelerate wear and tear on the joint surface over time, leading to arthritis. However, since you're asymptomatic for the most part currently, it's difficult to predict your exact progression without a thorough examination.

Actionable Next Steps:

1. Monitor Symptoms: Keep track of any changes in pain, stiffness, or functionality in your big toe. Note how often you experience the “twitching” sensation and if it worsens or affects your daily activities.

2. Consult a Specialist: A second opinion from an orthopedic surgeon, preferably one who specializes in foot and ankle conditions, can provide more tailored insights. They can assess whether surgical intervention would be beneficial, given your current symptoms and activity level.

3. Consider Physical Therapy: Engaging a physical therapist could help evaluate your toe's strength, flexibility, and mobility and provide you with specific exercises to improve its function. Strengthening the surrounding muscles might help in compensating for the stiffness and perceived weakness.

4. Lifestyle Adjustments: Continue to pay attention to your body's response to physical activities and consider modifying exercises if you notice any discomfort or limitations regarding your toe.

In summary, while your current condition may not require immediate intervention, being proactive about your toe's health can help prevent potential issues in the future. Please don't hesitate to ask if you have further questions or need additional details!