Management of Great Toe Abrasion
Clean the abrasion thoroughly with large volumes of warm or room temperature tap water until all foreign matter is removed, apply antibiotic ointment (bacitracin or mupirocin) if the patient has no allergies, cover with a clean occlusive dressing, and instruct the patient to monitor for signs of infection including increasing redness, warmth, swelling, purulent drainage, or fever. 1, 2, 3
Immediate Wound Care
- Irrigate the abrasion extensively with warm or room temperature potable water with or without soap until no foreign debris remains in the wound—cold water is equally effective but less comfortable 1
- Apply antibiotic ointment or cream only if the wound is superficial and the patient has no known allergies to the antibiotic 1
- Cover with a clean occlusive dressing—wounds heal better with less infection when covered 1
- The area may be covered with a gauze dressing if desired 2, 3
Critical Signs of Infection to Monitor
Instruct the patient to watch for these specific warning signs and seek immediate medical attention if they develop:
Local Signs of Infection
- Increasing redness spreading beyond the initial wound margins 1
- Warmth at the site that worsens rather than improves 1
- Swelling that progresses over 24-48 hours 1
- Purulent drainage (pus) or foul-smelling discharge 1
- Increasing pain rather than gradual improvement 1
Systemic Signs Requiring Urgent Evaluation
- Fever (temperature >38°C/100.4°F) 4
- Red streaking extending up the foot or leg (lymphangitis) 1
- Chills or feeling systemically unwell 4
- Rapid progression of redness or swelling 1
Follow-Up Instructions
- Re-evaluate within 3-5 days if the wound is not showing clinical improvement 2
- Keep the nail as short as possible to prevent trauma to the healing abrasion 1
- Wear protective footwear to avoid re-injury and contamination 1
- Avoid walking barefoot in public areas like gyms, pools, or hotel rooms where bacterial and fungal pathogens are common 1
Special Considerations for the Great Toe
The great toe warrants particular attention because:
- Anatomical vulnerability: The great toe is supplied by three source arteries and connected to much of the foot via tendons, meaning infections can spread more readily along these structures 5
- Higher risk of complications: Great toe injuries and infections are associated with higher rates of complications compared to lesser toes 5
- Functional importance: The great toe is critical for gait and weight-bearing, so any infection that progresses can result in significant disability 6, 7
Common Pitfalls to Avoid
- Do not use superficial swab cultures if infection develops—these yield contaminants and are unreliable 1
- Do not delay seeking care if signs of infection appear—early intervention prevents deep tissue involvement 1
- Do not apply ice directly to the wound as this can cause tissue ischemia 1
- Avoid tight or restrictive footwear during healing as this increases risk of trauma and infection 1