Learn to protect your toes from trauma on the trail

There are many ways to get bumps and bruises out there on the trail, but the big toe always seems to be the first one to the crash. In most people, this is because it is the longest toe. This is too bad, since the big toe can really complain, especially if the big toenail is injured.

Here are some suggestions as to how to respond to a toe injury like this, and how to protect them so that you can finish the hike. As usual, it starts with avoiding injury.

Take a look at your toes again, and especially the big toe. There is a lot of stress on the toes, especially the big toe, when you walk or run.

First, make sure you have enough room in your shoe to prevent constant excess pressure and stress. Make sure your shoes have a large enough toe box the area at the front of the shoe.

Next, make sure there is adequate protection on the top of the shoe. Many of the newer shoes for hiking and climbing are very flexible and pliable, but they may leave the toes at risk for getting injured. There should be adequate protection on the surface of the shoe to prevent the toes getting crushed by things like logs, sticks, rocks and coolers.

There are hiking boots out there that have extra protection for the toes, even some with a steel layer, that can go a long way to avoiding turning your big toe into a two-dimensional object. These steel-tip shoes are especially helpful if you have a history of toe injury and want to make sure further problems are avoided.

Remember that the foot goes forward at about 20 mph as you walk, so if you hit something, think of your car running into a wall at about that speed.

Also, when you drop something, remember the toes are in the line of fire. In fact, it is amazing that the toes can take so many traumas. Injuries can and will occur, so you need to have a plan.

If you injure your toe ...

Once you are calm enough to take a look at it, see if it is still aimed in the right direction. If it is off at an angle, it is either dislocated (unusual) or fractured (most common). You also need to see if the toenail is still in place, and if there is a split in the skin. What these tell you is the severity of the injury and what you need to do about it.

Here are a few suggestions for emergency treatment for injuries before you get to the doctor:

If the toe is in the correct orientation not bent at a sharp angle and the skin and nail are still intact, you will only need to protect it from further damage until you can get it evaluated medically. In this instance, splinting it can be very helpful.

There are several ways to do this, but one of the easiest is to put some cloth or soft paper between the injured toe and the one next to it. Then gently tape these two toes together. The second toe acts as a splint for the injured toe. Remember to make the taping loose enough to accommodate the swelling.

Also, make sure you adjust your shoelaces so that there is extra room around the toes, while the forefoot is tight enough to prevent the foot from slipping forward in the shoe as you walk. If you can borrow a larger shoe, put on extra socks for padding.

If you look at the toe and it is at an unusual angle, then you have to adjust things a bit. If you are in a situation to get transported to an emergency room, this would be best. They can get an X-ray to see what has happened and also give you some numbing medicine before they adjust it.

If you are not near an emergency room, you may have to straighten the toe to fit it in the boot or shoe again. Cooling the toe down with ice, if you have it, can make the adjustment less painful. After this, you will need a splint. One place to look for a splint is in your pack. Take out a camping spoon if you have one, bend it to fit on the top of the foot and out over the injured toe, and gently tape it down. Sounds odd, but with this over the injured toe you can hike out with less pain.

Now, if the toenail is split or has come loose, or the skin is broken, you will have to deal with this, too. Usually, it is best to keep the toenail in place and use it as a splint over the injured toe. Gently put it back over the toenail bed. Then, cover the injured toe with a sterile or at least clean bandage applied loosely to avoid too much pressure. After that, tape the injured toe to the one next to it for support, and cover with a spoon splint, and off you go to the emergency room for the next level of treatment. The split nail and injury to the nail bed may require surgical repair.

The key is to take care of toe injuries in a way that prevents further trauma and pain. Use these suggestions to help you bridge the gap between the injury and the doctor's office.

Let the situation heal adequately before you head out on the trail again, and you should do well on your next hike probably with more attention to your feet.

Paul Collins, M.D. is an orthopedic surgeon specializing in sports medicine at Intermountain Orthopedic in Boise. Please send your sports medicine questions to Bridget Lux at outdoors@idahostatesman.com or at The Idaho Statesman, P.O. Box 40, Boise, ID 83707.

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