Broken Toe or Sprained Toe? How to Tell the Difference

You kick the corner of the bed frame at 2 AM, and your toe explodes with pain. It swells. It turns purple. You can still walk on it, so you assume it's just a bad sprain and move on with your life. Two weeks later it still hurts, and you start wondering: was it actually broken?

This scenario plays out constantly. Toe injuries are the most commonly self-diagnosed and self-treated injuries in the foot, and many fractures go undiagnosed because people assume that if they can walk, it's not broken. That assumption is wrong — and it can lead to problems.

Sprain vs. Fracture: The Basics

A sprain is a ligament injury. Ligaments connect bone to bone, and when a toe is forcefully bent, twisted, or hyperextended, the ligaments around the joint stretch or tear. This causes pain, swelling, and bruising centered around the joint.

A fracture is a break in the bone itself. Toe fractures typically occur from direct trauma (dropping something heavy on the toe, kicking a hard object) or from repetitive stress. The pain is usually at the bone rather than the joint, and certain fracture patterns can cause angular deformity.

How to Tell the Difference

There's significant overlap in symptoms, which is why clinical examination and X-rays are often needed for a definitive answer. However, certain clues point in one direction or the other.

Signs that favor a fracture: pain directly over the bone (mid-shaft) rather than the joint, visible deformity or abnormal angle, a cracking sound at the time of injury, pain that worsens when pressing directly on the bone, swelling that persists or worsens after 48 hours, and inability to bear weight on the toe during push-off. Subungual hematoma (bleeding under the toenail) also frequently accompanies fractures of the distal phalanx.

Signs that favor a sprain: pain centered at the toe joint, ability to move the toe through its normal range (painful but possible), swelling that peaks within 24–48 hours then gradually improves, and bruising that stays relatively localized.

The honest truth: without imaging, even experienced clinicians sometimes can't distinguish the two with certainty. An X-ray takes less than five minutes and provides a definitive answer.

Why It Matters

"It's just a toe" is the phrase we hear most often. But untreated toe fractures can cause real problems. A fracture that heals in a maligned position can permanently alter the mechanics of push-off during gait, causing pain and calluses. An intra-articular fracture (involving the joint surface) that heals improperly leads to traumatic arthritis. A displaced fracture of the big toe that isn't corrected can affect balance and gait for years.

Lesser toe fractures (toes 2–5) are generally more forgiving. Most heal well with buddy taping and a stiff-soled shoe. But the big toe — the hallux — carries a disproportionate share of your body weight during walking. Fractures of the big toe, especially those involving the joint or the sesamoid bones, deserve careful evaluation and management.

When to Get It Checked

Not every stubbed toe needs a podiatrist visit. But the following situations warrant an evaluation. Pain that doesn't begin improving within 3–5 days. Visible deformity — the toe points in a different direction than it used to. Significant swelling that hasn't improved after 48 hours of RICE (rest, ice, compression, elevation). Bruising under the toenail. Numbness or tingling in the toe. Any big toe injury with moderate-to-severe pain. And any toe injury in a patient with diabetes or peripheral neuropathy, where complications are more likely.

Treatment Approach

For confirmed simple fractures, treatment typically involves buddy taping (splinting the injured toe to the adjacent one for stability), a stiff-soled shoe or surgical shoe to limit toe flexion during walking, icing and elevation to manage swelling, and activity modification for 4–6 weeks.

Displaced fractures may need closed reduction — manually realigning the bone under local anesthesia. Occasionally, fractures involving the joint surface or severely displaced fractures require surgical fixation with a small pin or screw. This is more common with big toe fractures and crush injuries.

For sprains, treatment is similar but recovery is generally faster — typically 1–3 weeks for mild sprains, 3–6 weeks for more significant ligament injuries. The joint may benefit from gentle range-of-motion exercises once acute pain subsides to prevent stiffness.

The bottom line: if you hurt your toe and it still hurts after a few days, it's worth getting an X-ray. A quick evaluation now can prevent a much longer problem later.