Broken Toe? Treatments Can Help These Small Bones Heal

Broken Toe? Treatments Can Help These Small Bones Heal

Broken toes are a common injury among children, who frequently stub their toes, drop heavy objects on them or close them in doors or cabinets. If your child breaks a toe, you, like many people, may assume nothing can be done. That’s a common misconception. Your child’s provider has many options for treating broken toes, and treatment is less complex than you may think.

Broken toe treatment can reduce your child’s pain and help them get back to being a kid.

Signs Your Child’s Toe May Be Broken

Each toe consists of two or three bones, as well as toe joints. Broken toes can range in severity from small hairline toe fractures to multiple breaks in a bone. 

Symptoms of a broken toe include: 

·       A crooked toe or toe that appears to be out of place 

·       Bruising and swelling, which may appear the day after the injury

·       Difficulty walking

·       Pain at the specific area of injury, also known as pinpoint pain 

·       Stiffness 

If you suspect your child has a broken toe, visit your child’s pediatrician or an urgent care clinic. Visit an emergency room if your child has an open fracture, in which bone has broken through the skin. Open fractures can become infected and need immediate care.

Often, health care providers can diagnose a broken toe with a physical exam. Your child’s provider may order an X-ray to find the exact location of the break and determine whether the toe is dislocated.

How to Treat a Broken Toe

Broken big toes and severe fractures may require casting and, rarely, surgery. However, most broken toes will heal with at-home care or basic medical treatments. Your child’s provider will likely recommend one of the following:

·       Rest. Your child will need to avoid putting unnecessary weight on the injured toe. Elevating the foot on a pillow can help with swelling.

·       Ice. Ice packs can also reduce swelling when placed on a broken toe for 10 to 20 minutes every one to two hours. Apply ice for three days or until the toe is no longer swollen.

·       Over-the-counter pain relievers. Acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) can reduce pain but follow dosing instructions closely. Do not give children aspirin unless their provider says it’s OK. Aspirin can increase the risk of Reye syndrome

·       Proper footwear. If your child needs to wear shoes, have them choose a wide, stiff-bottomed shoe that doesn’t put pressure on the injured toe but also keeps it in proper alignment. Depending on the extent of the fracture, your child’s provider may recommend a special boot while the toe heals.

·       Splinting. Your child’s provider may recommend a toe splint to hold the broken toe in place as it heals.

·       Taping. A common treatment known as buddy taping involves taping the injured toe to the healthy toe next to it. It’s not always helpful, so ask your provider first. The provider can also show you how to tape the toe properly.

Children shouldn’t walk on the toe until they can put pressure on it without feeling a lot of pain. Also, attend follow-up visits if you have them. Your child’s provider will examine the toe to ensure it is healing properly. 

Broken toes may need six to eight weeks to heal, according to the American Academy of Orthopaedic Surgeons, so be patient. 

Call your child’s provider if your child has any of these symptoms as the toe heals: 

·       Fever or chills, which could be signs of an infection

·       Tingling or numbness in the toe

·       Pain or swelling that gets worse, not better

·       Red streaks appearing on the foot or toe

Can a Broken Toe Heal on Its Own?

Broken toes can heal on their own, but treatment helps ensure better outcomes. Left untreated, broken toes may heal crooked, your child could develop chronic foot pain or he or she may have problems walking. 

Broken Toe vs. Stress Fracture

Active children and children who play sports may think they have a broken toe when they actually have an overuse injury. Activities that involve repetitive motions, such as running, or place significant force on the feet, such as basketball, can cause stress fractures, a type of overuse injury in which small cracks or painful bruising develop in the bones.

The ball of the foot has two small bones called sesamoids located below the big toe joint. Overuse can lead to a sesamoid stress fracture, which can cause pain and swelling near the base of the big toe. A sports medicine specialist can diagnose and treat these stress fractures and help your child prevent another overuse injury.

If you’ve visited an urgent care or emergency room and your child has a confirmed fracture, bring your child’s X-rays to our walk-in Fracture Clinic for help. The clinic is located at 5700 Dallas Parkway in Frisco and open from 7:30 – 9:30 a.m., Monday through Friday. For suspected fractures, schedule an appointment by calling 469-515-7200

Movement Science – Breaking Down Movements in Young Baseball Players

Movement Science – Breaking Down Movements in Young Baseball Players

As part of SAFE (Sports-specific Assessment and Functional Evaluation), our team is developing sport-specific protocols for the use of motion capture technology in sports medicine that are being used across the country. There are only a handful of sports that have received attention in the motion capture world, and those are typically performance-based models. The models that our team are creating evaluate foundational movements to help us predict injuries and improve return to play protocols. To do this, we will need to record a great deal of data from a large number of athletes.

For the past two summers, our Movement Science Lab team in Frisco has collected data sets on our baseball program participants and some other volunteers. Though we are just getting started on the total number of athletes to test, we are making great progress on tweaking the protocol and looking at preliminary results to understand where to go next. Here are a few things that we are looking at in the study:

Trunk mobility – specifically in the thoracic spine. We’ve identified the best way to capture the mobility of the upper spine. We believe that tightness there may affect the stress on the shoulder during throwing.

 
Motion throughout the body while throwing. Because our movement science lab is spacious, with 14-camera motion capture system, we can monitor joint angles, speed and forces throughout the body during high velocity pitching. We believe some movements are directly related to the development of elbow and shoulder injuries, particularly when there is a high volume of throws without rest.

 
Single leg stability with motion. Most sports require movement of the legs, and most of the time, only one leg is in contact with the ground. We are measuring the differences from side to side and between athletes to identify asymmetry in static and dynamic single leg movements. We believe asymmetry is a factor for increased injury risk in all athletes.

 
Leader of the project and assistant director of the Movement Science Lab in Frisco, Sophia Ulman, Ph.D., says, “Early results from this study are helping us to establish an evidence-based return to play decision-making model.” Many have heard of functional testing or return to play testing for athletes returning to sport after a significant knee surgery, such as an ACL reconstruction. This new upper extremity program is much needed in the pediatric sports medicine community. As we continue to collect information about healthy athletes, we will use the results to continue to modify the upper extremity return to play program. This is an example of where our clinical teams of physicians, physician assistants and physical therapists collaborate with our research team to make changes that impact athletes today.

We are continuing to work on this baseball project and invite healthy young athletes to help us. We schedule testing dates periodically and would be happy to send you the calendar to sign up or work with your team to find a date to do testing together.

To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org

A Shared Passion to Protect and Serve

A Shared Passion to Protect and Serve

Published in Rite Up, 2023 – Issue 3. 
 
Last summer, the Inpatient Unit at Scottish Rite for Children had extra security and cuteness overload in the form of a 4-year-old patient lovingly referred to as Policeman Joseph. Donning a police vest, badge, walkie-talkie and binoculars, Joseph, of Gonzales, Louisiana, made daily rounds to keep his fellow patients safe. “He’s got a huge personality stuffed inside a little body,” says Randi, his mother.
 
Joseph has congenital kyphoscoliosis. In utero, his vertebrae formed differently, which caused both kyphosis, or an outward spinal curve, and scoliosis, a sideways curve. At age 2, Joseph was referred to Scottish Rite for Children where he received expert care from pediatric orthopedic surgeon Amy L. McIntosh, M.D.

When Dr. McIntosh evaluated Joseph, his curve measured more than 80°, which was beyond the point when surgery is recommended. “For young children who have severe congenital curves, bracing or casting doesn’t help because of the abnormal vertebrae,” Dr. McIntosh says. “You have to wait until they’re big enough to surgically fit an implant in them.” Dr. McIntosh monitored Joseph until he was 4. When his curve reached 100°, she recommended six weeks of halo-gravity traction followed by surgery.

Halo-gravity traction gently stretches and straightens a significantly curved spine in a slow, safe manner. “It’s like taking a spring that’s coiled up and slowly uncoiling it over time,” Dr. McIntosh says. While Joseph was under anesthesia, Dr. McIntosh applied the halo by attaching it to his skull. “I didn’t even feel it,” Joseph says. “It was super magic!” With the help of his care team, Joseph could fasten his halo to a traction device on a pulley system that connected to his walker, wheelchair or bed.
 
While in traction, Joseph participated in therapeutic recreation, physical therapy (PT) and fun activities in Child Life. “He made friends with everyone, especially the security officers,” Randi says, “and he loved growing his muscles in PT, so he could keep his new friends safe. Scottish Rite became our second family, a home away from home.”
 
When traction was complete, Joseph underwent surgery. Dr. McIntosh inserted a magnetic growing rod, also known as the MAGEC® System, on one side of his spine and a sliding traditional growing rod on the other side. After a successful procedure, his curve measured 42° — a correction of almost 60%. “He got almost two inches taller,” Dr. McIntosh says.

 Going forward, the rods in Joseph’s back will be lengthened as he grows. Rather than undergoing multiple surgeries, an external magnetic device will be used to locate the magnet inside the rod to lengthen it. “The magnetic rod acts as a motor to drive the traditional rod that will slide,” Dr. McIntosh says. This hybrid construct will control the correction of Joseph’s spine until he stops growing and ultimately receives a definitive spinal surgery. “Joseph’s care has been top-notch,” Randi says. “Dr. McIntosh is absolutely the best, a true godsend.”
 
On his last day at Scottish Rite, Policeman Joseph made his final rounds, protecting the kids and doing a celebratory safety dance on his way out.
 
Read the full issue.

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

We are honored to announce the appointment of Megan E. Johnson, M.D., as program director for the Dorothy & Bryant Edwards Fellowship in Pediatric Orthopedics and Scoliosis at Scottish Rite for Children. The Edwards fellowship is one of the oldest and largest fellowships in the country and has an alumni of nearly 200 surgeons.  
 
With this new appointment, Dr. Johnson will be responsible for attracting outstanding candidates from diverse backgrounds and training them to be skilled clinicians and surgeons. Dr. Johnson will ensure ongoing maintenance of a high-quality educational curriculum for our fellows and provide leadership and direction to our orthopedic faculty who take part in education. She will have a key role in ensuring our curriculum is undergoing needed innovation through regular program evaluation and quality improvement.
 
Dr. Johnson received her medical degree and completed residency training at Vanderbilt University in Nashville, Tennessee. She completed her pediatric orthopedic fellowship at Scottish Rite for Children in 2015, and following her fellowship, she returned to Vanderbilt University Medical Center. She joined the Scottish Rite for Children staff in 2020 as a pediatric orthopedic surgeon. Her clinical practice focuses on spine deformity in the pediatric population. She also treats patients with spina bifida, not only for their spine conditions but also for lower extremity issues. Dr. Johnson also serves as the Medical Director of Ambulatory Care and is an assistant professor of Orthopaedic Surgery at UT Southwestern Medical Center. 
 
“Dr. Johnson is an excellent clinician in the outpatient, inpatient and surgical setting and is an extremely talented surgeon who takes on both the straightforward as well as the complex deformities,” says Chief of Staff Daniel J. Sucato, M.D., M.S. “Not only is she a great leader, but she also has a natural ability to educate and is one of the favorites of our fellows to work with in the operating room and clinics.”
 
Dr. Johnson succeeds Dr. Sucato, who has served as program director of the Pediatric Orthopedic Surgery Fellowship program for the past 10 years. Dr. Sucato will remain Chief of Staff of Scottish Rite for Children as well as the director of Scottish Rite for Children’s Center for Excellence in Spine.

Get to Know our Staff: Judy Sneed, Center for Dyslexia

Get to Know our Staff: Judy Sneed, Center for Dyslexia

What is your job title/your role at Scottish Rite for Children? 
I am a department assistant within the Luke Waites Center for Dyslexia and Learning Disorders.

What do you do on a daily basis or what sort of duties do you have at work?
My duties include handling patient check-ins, managing the digital platform for center applications, monitoring the approved patient file process and phone coverage.

What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My first job was working for Cigna Healthcare filing medical records as a teenager. My dad helped me get the job.

The path that led me Scottish Rite was after I worked in Student Discipline at a local high school. This gave me a unique perspective on how unchecked academic learning disorders affected older children daily in an educational environment. A friend reached out that had been recently hired within the department regarding an opportunity to join the center, and the rest is history. I will have worked here for three years in January 2024.

What do you enjoy most about Scottish Rite?
I enjoy assisting parents, guardians and their children with navigating our evaluation process. I am here to listen to their stories regarding their fears and anxiety about their children’s educational future and see them realizing there is help and hope to help further their children’s academic success.

Tell us something about your job that others might not already know?
I am also certified to conduct vision and hearing screening.

Where is the most interesting place you’ve been?
In 2022, I was able to spend 12 amazing days in Australia visiting Sydney, Melbourne and Port Douglas (where the Great Barrier Reef is located). More destinations soon to come.

If you could only eat one meal for the rest of your life, what would it be?
Some kind of potato meal. If anyone knows me personally, I have loved french fries or any kind of potatoes for as long as I can remember, except for yams or sweet potatoes. Not a fan!

If you could go back in time, what year would you travel to?

The late ‘80s, 1989 – 1990. I had just completed high school and was wide-eyed about my future and was just about to meet someone that would make a tremendous impact on my life then and now.

What three items would you take with you on a deserted island?
I hate making assumptions, however, assuming there would be no electricity, I guess my Bible, some seeds and some fabric. No one in their right mind would be anywhere without food or clothing, plus if I was alone, what an amazing book to let me know I really wasn’t and to provide me with hope of a change in my situation.

What’s one fun fact about yourself?
I worked to replace an engine fan assembly on a classic convertible truck I once owned. Go YouTube University!