Dr Julius Parker: Broken toes and grommets

Q I broke my big toe while playing football three weeks ago. My GP taped it up to the toe next to it and said, with rest, it should get better within a couple of weeks. But the toe is still painful and is bruised.

A Sports- and work-related trauma are the commonest reasons for fracturing a toe. Your GP has treated you with “neighbour (or “buddy”) strapping. This stabilises the broken toe, reducing its movement, while it heals. Strapping is effective although you should put a small piece of cotton or gauze between the strapped toes to prevent the skin rubbing. When you restrap the toes after a shower or bath, make sure they are not too tightly pressed.

Use Paracetamol and/or an anti-inflammatory, such as Ibuprofen, for pain, if required. Check with your pharmacist or GP if you’re already taking other medication or have pre-existing medical conditions. Your toe will look swollen and bruised. Because the big toe takes much of the body’s weight in walking, restrict your activities. When resting, elevate your foot, until the swelling has improved.

By three weeks, I wouldn’t have expected the pain to have settled, but pain and bruising should be reducing. If they are, I anticipate continuing improvement over the next two to three weeks. You may have pain, especially when you walk and exercise, for two to three months after that.

You should see your GP if the pain is worsening, if the toe is out of position, or if you have a reddened, painful or oozing area of skin, as this may suggest an infection.

Most big-toe fractures heal without longer-term problems, so I would wait a few more weeks.

Q Our four-year-old daughter is due to get grommets inserted in two weeks’ time. She is anxious about the operation and is saying she doesn’t want to go. What do you suggest?

A Forward planning will help you and your child. If you appear calm and relaxed (even if you’re not!) this will help your daughter. Most hospitals reassure children and explain what is happening in a way a child can understand.

A common pre-school age anxiety is that they will be separated from their parent and left alone, so most hospitals let a parent into the pre-anaesthetic area to be there when children are coming round after anaesthetic. Although this may sound strange to an adult, children may worry they have done something wrong and that’s why they need an operation. Reassure your daughter and say it’s being done to fix her ears.

It’s helpful to ‘practice’ beforehand. Explain that fitting grommets in your daughter’s ear(s) will help her hear better, and stop her getting ear infections, but to do this a doctor will need to have a special look in her ear(s) while she’s asleep. Most people, whether children or adults, fear pain and you can say she’ll have medicines to prevent it.

If you have or buy a “doctor or nurse kit”, you can practice on some of her toys, taking their temperature, listening to their chest, and putting on a bandage. These things will happen in hospital. You can remind your daughter to tell her toys how brave they’ve been and that you’ll give her a kiss and a cuddle.

Take in your daughter’s favourite toy or blanket on the day. There are a number of books available, but I like the Usborne First Experiences series Going to the Hospital. If you visit some hospital websites, you’ll often find tips on preparing children who are coming into hospital for surgery. You can also get advice from a number of parenting sites.

I hope all goes well.


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