Sorry, this is a bit long . . . My almost 14 year old daughter broke her big toe back in November. A piece of bone completely broke off at the top joint. We took her to a pediatric orthopedist and she was put in a boot for about 4-5 weeks. When the boot came off she was instructed to wear good shoes with hard soles, and no physical activity. Within 2 weeks we were back at the orthopedist because she was still in a lot of pain. The x-ray showed that although the break was healing, it was still there. We even did an MRI to be sure there wasn't any other damage (such as soft tissue/nerve damage which wouldn't show up in an x-ray). In the end she wound up being put in a cast, to completely immobilize the toe (the boot didn't offer complete immobilization). The cast was removed after four weeks. But guess what? We were back at the orthopedist today (one month after the cast came off). The break is still not completely healed and still causing pain. The problem is the location of the break -- it is at the top joint of the big toe, which we all roll off of through normal walking (and take for granted!). So anytime she's walking in just regular shoes, even ones with good soles, she is stressing the break which is making it difficult for it to heal completely (sort of like when you pick a scab off of a cut - the cut doesn't heal). The orthopedist suggested putting her into a cast again for another month and let's see what happens. And if there's still pain after that, put her in a cast again . . . essentially it could take several more months to allow it to heal, likely with the aid of a cast to enforce immobilization. The other option is to have a couple of small screws put in which would pretty much create compression on the fracture, almost ensuring the bone will heal. Recovery would be about 4-6 weeks in a cast. The orthopedist said “if it was my daughter, I would put her in a cast and, if it still wasn’t completely healed, put her in a cast again, and again if necessary . . . because it will eventually heal.”
Oh, did I mention my daughter plays sports? She has played soccer since she was 5 and LOVES it. She also plays tennis. She had planned to play basketball for her 8th grade year, but the broken toe put an end to that! She hasn't been able to play soccer for months - the spring season is wrapping up and she won't be able to play in tournaments planned for May and early June. She wanted to play tennis at school as well . . . but again, that didn't happen. She has been absolutely miserable not being able to play any sports; I would even say she's been in a slight depression for a couple of months now (which we have talked about).
So at this point I’m pretty much ready to go ahead and get the screws put in, even if that’s not what the orthopedist would do if it were his daughter! My daughter is completely on board with doing it because the idea of this taking MONTHS more to heal is not at all appealing. I mean, she could very well start high school in August and still not be healed! And she wants to try out for soccer at school, get back to playing on her regular soccer team, start playing tennis again . . . . and I want to see her out there doing all the things that make her happy and complete her!
So, are we nuts to want to put her under the knife and get healed in 4-6 weeks? Or should we “stay the course” with the more conservative approach, looking at probably 3-4 more months of recovery?
Thank you so much for all of your input! We are going to get a second opinion from another pediatric orthopedist. After reading some of the responses about how their podiatrists/orthopedists have said to avoid foot surgery if at all possible, it has given me pause to follow that course of action. And it has also been helpful to hear from others who have had broken bones in their foot and have also experienced long recovery times. I was really thinking my daughter's healing time is an anomaly, but apparently not!
Lynn S. - she slammed the car door on her toe while not wearing shoes. Freak accident, but she's very hard on herself about it.
I would probably take the advice of my trusted orthopedist.
I know it's disappointing.
While it may be "quicker" there's gotta be something about putting scores in a toe that young, if not absolutely necessary. Ask!
I'd have the screws put in if it were me. The way I look at it, she'll never really play sports again if this thing isn't fixed. Queenofthecastle is right.
So sorry.
My senior year of high school I broke a bone in my foot, right before the beginning of my softball season. It never healed properly. I missed my entire senior season of softball and had to sit the bench while my team played in the state tournament. It still didn't heal during college, nor later. Here I am, 13 years later and I still have some pain from it when I run.
If I were in your daughter's shoes (pun intended), I would want the surgery. There's only so much time to do the things you want in high school. Maybe that's not a good enough reason, but that's what I would want.
Avoid surgery. Let it heal the right way and go with the orthopedist's recommendation. That's why you go to him for advice, correct? You could get a second opinion, of course.
Here's the thing. Your daughter really, really needs to take it easy and allow that foot to heal. Yes, she's active and it's difficult but she's young and it's only a few months. Not years. She's not losing out on the best months of her life. Surgery itself and healing from surgery can all sorts of complications that you and your daughter aren't even thinking of, and for some reason you're both thinking that a surgery will make this all go more quickly.
I have to say that as someone who has has broken every limb and every appendage including fingers and toes, I'm finding it difficult to believe that your daughter is allowing her foot to heal the way she's supposed to. At the same time, you have to remember that knitting bones is serious business. If she doesn't allow proper healing then she'll always have trouble with that foot, let alone that toe, and it really will affect how she plays sports in the future.
This can be a time where she learns about patience. She's going to have to learn to cope for a few more months, like it or not. You're the mom. She doesn't get to have a say with something this serious. Get her crutches in order to stay off the foot. I don't know why they use the boots in the first place. I've only seen them aggravate injuries and make fractures worse to the point of causing bigger breaks and sprains and even fostering blood clots because the person is allowed to walk on a broken bone.
Anyway, that's my TLDR way of saying to listen to the orthopedist. I think it's the most responsible thing to do.
A good podiatrist once told me that you want to avoid surgery on your foot at all costs because you could end up in far worse pain constantly. Sounds like you have a good podiatrist and would heed his advice.
if a surgeon says do not do the surgery..then do not do the surgery.. yes the surgery would be faster.. but the end result is the same.. she will heal with the cast.. she will heal witht he surgery and the cast.. I would nto risk surgery and possible infection...
also sometimes you need a second surgery to remove the screws after a time...
For any broken bone I ever had, I was always in a plaster cast for a solid 8 weeks.
I don't understand why they keep taking her out of a cast after 5 weeks.
This has dragged on for 6 months already.
If they'd kept her in a cast for a solid 2-3 months she'd be done with it already.
No matter how she heals she's going to be forecasting changes in the weather with this for the rest of her life.
Realize she might always have pains with it surgery or no surgery.
I know a friends son who was all set up for a soccer scholarship when he broke his ankle badly with a fairly complicated fracture - in a soccer game no less.
It took a long time to heal and he had multiple surgeries on it - his soccer days were over.
After that the best he could do was play golf.
He was pretty broken up about it at the time.
He's grown up now, married with kids of his own.
His life just took an unexpected turn but this other path he's on isn't so bad.
Once it's healed up, maybe she can take up swimming - it won't be so hard on her toe as running around on it will be.
My podiatrist and orthopedic told me to avoid foot surgery at all cost. They told me my foot would never be the same if I had surgery so they recommended not to.
Feet are notorious for slow healing. My friend had to have surgery on her foot though....they inserted pins....she ended up with an infection which I believe is not all that unusual when you have foot surgery...long story short she ended up having another surgery to clear the infection that went to her bone and then she spent 3 wks going to the hospital to be placed in an oxygen tent for 3 hours a day to promote healing. She was very lucky she didn't loose her foot. Personally, I would take the advice of your daughter's doctors. I find it hard to believe that the doctors could guarrentee that she will be better in 4-6 wks. She should have been healed after being put in a cast and boot too but the fact is she is not. Sorry, I know that is not what you want to hear. Could you get a second opinion?
FYI... It took my foot 1 1/2 years to heal but it is finally better.
We live in a sports oriented community. My kids are currently on seven teams between them so I know how important it is, but it's also short term and just for the here & now. I would really consider the screw/s being in her toe for a lifetime. I have two screws below my knee due to a bone tumor and it hurts even after 15 years. The big toe takes more stress than you realize. I would get another opinion and then let her heal the rest of Spring & Summer. I know she feels her life is over, but she can play again, just not right now. She's not thinking of the constant pain for the rest of her life (and no kid would). Screws or not she is going to have to give it time to heal. I'm so sorry for the position you're in.
My first reaction was to say ahead with the surgery. I'm not the type who believes in avoiding surgery at all costs (my husband is a doctor, so I tend to trust the medical profession...) and i would want this fixed quickly and correcly. But then i read the responses that said their orthopods told them to avoid foot surgery at all costs. Did you ask your surgeon why he wouldn't choose surgery for his own daughter? If the guy doing the surgery wouldn't recommend it for his own child, there must be a very good reason to avoid it. I would ask him to explain exactly why he recommends continuing with the casts and make my decision based on his response. If you do decide to go with the cast, make sure she uses her crutches 100% of the time. She must have been walking on it (probably without your knowledge) while in the first cast or it seems like it would have had enough time to heal.
Good luck with whatever you decide to do. I feel for your daughter being unable to participate in the sports that she loves. And I know it's hard for you to watch her go through this :-(. I hope this ends for both of you very soon.
Btw, how the heck did she break off the end of her toe?? Thinking of that gives me the willies!
After reading your question and all the answers my vote is a second opinion and go from there.
Having had a greenstick fracture with my right foot (which I rebroke once since) I can tell you it takes FOREVER for extremity fractures to heal, even under the most ideal circumstances. The reason being that the feet are the farthest from the heart, therefore getting the tail end of the blood flow. Because of that, healing is just excrutiatingly slow.
I would just stay the course with the cast. It took a good year for me to recover from my fracture. It was very, very painful too, as are any breaks in the feet. The recovery on surgery may be 4-6 weeks, but that's just in the cast. Afterwards, it may still take a considerable amount of time for her to return to normal. These types of breaks are the WORST! So sorry.
When you have an orthopedic doc, who makes his big bucks doing surgeries and who enjoys doing surgeries, tell you that he would not do the surgery if it were his daughter, you need to listen carefully, and also thank your lucky stars that the guy isn't knife happy. Sure, a 2nd opinion can't hurt; make sure you find one of the best ortho docs in your city for it.
just leave it in the cast let it heal.
when I was a kid and broke my toe, it got taped to the one next to is and that was it. This is an awful lot for a broken toe.
How is her diet? I'd look at that if she's not healing yet, I'd look and see is she getting enough calcium and protein?
This is a tough one. I can only answer from the perspective of my husband, who has played rugby for more than 20 years, and has had many major injuries/surgeries. By far the worst surgeries he has been through are the ones that involve screws into bone. It's very, very painful. Sure, it may be a 4-6 week recovery, but the first month is in a Vicodin haze. (And my husband once played a game of rugby on what turned out to be a badly broken ankle, so he has an immense pain threshold.)
Something I'd ask is what would happen if she were to re-break that toe after the surgery. For instance, if someone stepped on her toe in soccer cleats? We have seen on my husband's rugby team that bone tends to shatter when it has screws in it and re-breaks. A friend of my husband's actually had his foot amputated because his re-constructed ankle broke and there was nothing left for the ortho to rebuild. Granted, this is just your daughter's toe, but it's a question I would ask the surgeon. Your daughter is active, and re-breaking it is not out of the realm of possibilities.
I don't know, if it were me, I'd put it in a cast and let it heal (could she have permission to swim, maybe, or something else to stay active?). But your daughter has been immobilized for a long time already... it's a really tough call. I'd talk it over with the surgeon and just see what the expected outcome would be, and what the future risks of having screws in there would be, and go from there.
Screw it..did I say that?
