Q: My teen's fractured toe isn't healing after 3 months and is now changing color and feels numb. Is this normal?

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Question:

My high school-aged child fractured their 4th and 5th toes on their right foot three months ago. After six weeks in a cast, the doctor said it was healing slowly. At our last check-up a month ago, the X-ray showed it still hadn't fully healed. The doctor said this was unusual but not a major problem, and to come back in three more months.

Lately, my child has noticed that the injured toes sometimes feel numb, especially in the cold. They also occasionally turn a dark, reddish-purple color, but the color returns to normal when they are warmed up. My child generally has cold hands and feet and what seems like poor circulation. I'm worried this could be something serious like necrosis. Should I get a second opinion, or is this just a part of a slow healing process? What do the color change and numbness mean?

Answer:

It's understandable to be worried about color changes and decreased sensation in a fractured area three months after the injury.

【Summary of the Current Situation】

• Three months post-fracture of the 4th and 5th toes, experiencing delayed union (slow healing).

• Recent onset of dark reddish discoloration in the area, decreased sensation, and worsening of symptoms in the cold.

• The patient has a history of cold extremities and a tendency for swelling.

【Red Flags Requiring Immediate Evaluation (If any of these occur, see an orthopedist today)】

• Toes turn black or gray, or blisters or ulcers develop.

• There is a foul odor or pus discharge.

• Severe swelling or pain spreads to the top of the foot or ankle.

• Complete inability to move the toes or a total loss of sensation.

If none of the above symptoms are present and the color returns to normal with warmth, poor circulation is the most likely cause. However, a three-month delayed union combined with new nerve and blood vessel symptoms warrants an interim check-up.

【What to Do Now】

1. Start a Photo Log Today: Take pictures of the toes when the color changes. Note the time, duration, and the color before and after warming the foot.

2. Prioritize Warmth: Have your child wear thick socks, maintain a warm indoor temperature, and avoid walking on cold floors.

3. Avoid Compression: Ensure shoes are not tight or constricting, as this can impede blood flow.

4. Elevate the Foot: When sitting, rest the foot on a cushion to help reduce swelling.

【Questions to Discuss with Your Doctor】

• "Should we investigate the cause of the delayed union? (e.g., Vitamin D, calcium levels, thyroid function)."

• "Could the color change and numbness be a sign of nerve or blood vessel damage? Would an ultrasound or nerve conduction study be necessary?"

• "Would physical therapy or treatments to improve circulation be helpful?"

【When to Consider a Second Opinion】

• If any of the "Red Flags" listed above appear.

• If the color changes and numbness worsen or persist despite keeping the foot warm for a week.

• If the current doctor continues to suggest "just wait" without a plan for further investigation.

→ In these cases, you might consider consulting a foot and ankle specialist or a pediatric orthopedist. It would be helpful to bring copies of the previous X-rays.

As a first step, I recommend calling your current doctor's office. Explain the new symptoms of color change and numbness and ask if your child needs to be seen before the next scheduled three-month follow-up. Most orthopedic practices take these changes seriously.

Start the photo log and warming measures today, and monitor the symptoms closely. Please let us know how things progress so we can help guide the next steps.

For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.

https://fevercoach.us