Painful. how do you know if a right pinky toe is broken or just bruised?

Xray: Only your radiologist knows for sure.

History/exam first: Bruised or broken pinkie toe is managed same...No casting needed--buddy taping may help. If you had significant trauma, then chance of frracture. If you can move the toe without intense pain, then likely not a fracture. Some pain is expected from the trauma/bruising! so xray is often not needed, but often requested by patient. So, if is badly sore/bruised, consult doc..Motrin may help! good luck..