Dr. Collins: Take time to care for your toes

Take a look at your toes, especially your big toe. The big toe takes a lot of stress when you walk or run, and it's awfully easy to hurt it running or biking in the Foothills.

The motion of the great toe has a lot to do with balance and springing off when you run, jump, climb or bike. Imagine how difficult it would be to do these things if your toes hurt every time.

To protect the toes, you have to respect them. First, make sure you have enough room in you shoe to prevent constant excess pressure and stress. I have found that some biking shoes are the worst — they are often built too small in the front of the shoe, an area called the toe box. Make sure your toes have enough room in that area, whether you're biking, hiking, running and even just walking.

If you're running in Robie Creek, you should make sure there is enough room in the front of your running shoes to allow the toes to properly push off and balance as you run. The shoes also need to have enough midfoot support to prevent your foot from slipping forward and causing trauma to the toes, especially on the downhill sections of the course.

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, but they may leave the toes at risk. There should be adequate protection on the surface of the shoe to prevent a crushing injury from objects such as logs, sticks, rocks and beer coolers.

Some hiking boots have extra protection for the toes; some even have a steel layer. Steel-toed shoes are especially helpful if you have a history of toe injuries and want to make sure more problems are avoided. Just ask any steel worker. Trying to hike out after a rock falls on your big toe is no fun at all.

The foot goes forward at about 20 mph as you walk, so if you hit something as you go along it is like your car running into a wall at that speed. Also, when you drop something you are carrying, your toes are right in the line of fire.

When you hurt your toes

If your toes and especially the big toe get smashed by a log or rock, first you need to stop dancing around holding it up. Once you are calm enough to look at it, see if it is still pointed in the right direction. If it is off at an angle, it either is dislocated (unusual) or fractured (most common).

You also need to see if the toenail is still in place and whether there is a split in the skin. What these injuries 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 — hopefully to make you more comfortable and safe while you hike out.

• 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.

Splinting 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. Make the taping loose enough to accommodate swelling.

You'll also want to adjust your shoelaces so there is extra room around the toes, but leaving the toe box tight enough to prevent the foot from slipping forward in the shoe as you walk. If you can borrow a larger shoe, put extra socks on for padding and use it. You may look like Bozo the Clown, but at least you will be walking.

If you look at the toe and it is at an unusual angle, then you have to adjust your plan a bit. If you can get transported to an emergency room, this would be best. There you can get an X-ray to see what has happened and get you some numbing medicine before doctors adjust it.

If you are not near an emergency room, you may have to straighten the toe up to fit it in the boot or shoe again. Cooling the toe down with some ice, if you have it, can make the adjustment less painful.

After this, you will need a splint. Check 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 in your "Bozo" shoes in much less pain. The spoon protects the injured toe from trauma.

Now, if the toenail is split or has come loose, or if the skin is broken, you will have to deal with this as well. It usually is best to keep the toenail in place and use it as a splint over the injured toe. Gently put it back over the nail 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. Borrow Bozo's shoe 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 here 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 it heal adequately before you head out again, and you should do well on your next hike or run — probably with more attention to your feet.

Paul Collins, M.D., is an orthopedic surgeon specializing in sports medicine at Orthopedic Health Care in Boise. Collins is an avid participant in many of Idaho's outdoor activities. Please send your sports medicine questions to outdoors@idahostatesman.com or at The Idaho Statesman, P.O. Box 40, Boise, ID 83707.

Source: www.idahostatesman.com