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If the broken bone fragments don't align together, the orthopedic surgeon will manipulate the pieces back into normal position a process called reduction. In some cases, reduction can be accomplished without invasive surgery depending on the number and positioning of the bone fragments. A local anesthetic is injected into the toe to numb the pain. If the skin is broken due to the trauma, stitches will be needed to close the wound and topical antiseptics administered. With open fractures, time is of the essence because of potential blood loss and the risk of infection or necrosis (local tissue death due to lack of oxygen). Strong painkillers such as narcotics may be prescribed until anesthesia is administered in the operating room. Sometimes with severe fractures, pins or screws may be required to hold the bones in place while they heal. Reduction isn't just used with open compound fractures; it is also used with any fracture with significant displacement. After a reduction of your broken toe, a splint is often put in place to support and protect the toe while it heals properly. Alternatively, you may have to wear a supportive compression boot, but either way, you'll likely need the use of crutches over the short term (two weeks or so). At this stage, minimizing walking and resting with your injured foot elevated is still highly recommended. Although splints provide support and cushioning, they don't provide much protection, so be extra careful not to bump your toe while walking. During the bone-healing phase, make sure your diet is rich in minerals, especially calcium, magnesium and boron, as well as vitamin D in order to promote bone strength. If more than one toe is broken or other bones of the forefoot are injured (such as the metatarsals), then your doctor might apply a plaster or fiberglass cast to your entire foot. Short-leg walking casts are also recommended if the fragments won't stay snugly together. Most broken bones heal successfully once they have been repositioned and are protected from further trauma or excessive pressure. Following surgery, and especially with the help of a cast, severely broken toes take six to eight weeks to heal, depending on the location and extent of the injury. After such a long time in a cast, your foot may need some rehabilitation as described below. After a week or two, your doctor may request another set of X-rays to ensure that the bones are aligned and healing properly.
Get reduction surgery. Wear a splint. Get a cast.