Epidemiology Incidence Toe fracture (Redirected from Toe Fracture) Contents 1 Background 2 Clinical Features 3 Differential Diagnosis 3.1 Foot and Toe Fractures 3.1.1 Hindfoot 3.1.2 Midfoot 3.1.3 Forefoot 4 Management 4.1 General Fracture Management 4.2 Immobilization 5 Disposition 6 See Also 7 References Background Bones of the foot. Smooth K-wires or screw osteosynthesis can be used to stabilize the fragment. Metatarsal Fractures - Foot & Ankle - Orthobullets Referral is indicated for patients with first metatarsal fractures with any displacement or angulation. . Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. Toe and forefoot fractures often result from trauma or direct injury to the bone. A 20-year-old male military recruit slams his index finger on a tank hatch and sustains the injury seen in Figure A. Following reduction, the nail bed of the fractured toe should lie in the same plane as the nail bed of the corresponding toe on the opposite foot. Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Some metatarsal fractures are stress fractures. The first toe has only two phalanges; the second through the fifth toes generally have three, but the fifth toe sometimes can have only two (Figure 1). Am Fam Physician, 2003. Thumb Fractures - OrthoInfo - AAOS A radiograph, bone scan, and MRI are found in Figures A-C, respectively. Copyright 2016 by the American Academy of Family Physicians. Stress fractures are typically caused by repetitive activity or pressure on the forefoot. Bruising or discoloration your foot may be red or ecchymotic ("black and blue"), Loss of sensation an indication of nerve injury, Head which makes a joint with the base of the toe, Neck the narrow area between the head and the shaft, Base which makes a joint with the midfoot. Injuries to this bone may act differently than fractures of the other four metatarsals. Bony deformity is often subtle or absent. X-rays. As the name implies a phalangeal fracture involves a fracture of any of the bones in the lesser toes. A fracture may also result if you accidentally hit the side of your foot on a piece of furniture on the ground and your toes are twisted or pulled sideways or in an awkward direction. (OBQ12.89) The talus has a head, constricted neck, and body. Fractures of the toes and forefoot are quite common. Search Evidence - orthobullets.com Transverse and short oblique proximal phalanx fractures generally are treated with Kirschner wires, although a stable short oblique transverse shaft fracture can be managed with an intrinsic plus splint. Phalanx Dislocations are common traumatic injury of the hand involving the proximal interphalangeal joint (PIP) or distal interphalangeal joint (DIP). Proximal phalanx fracture | Radiology Reference Article - Radiopaedia What is the optimal treatment for the proximal phalanx fracture shown in Figure A? Shaft. Surgery is required in the case of an open fracture, when there is significant displacement, or instability after reduction. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. CrossRef Google Scholar PubMed 7 DeVries, JG, Taefi, E, Bussewitz, BW, Hyer, CF, Lee, TH. A proximal phalanx is a bone just above and below the ball of your foot. Surgical fixation involves Kirchner wires or very small screws. Pediatrics, 2006. Management is influenced by the severity of the injury and the patient's activity level. A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. Comminution is common, especially with fractures of the distal phalanx. Maffulli, N., Epiphyseal injuries of the proximal phalanx of the hallux. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. Posterior splint; nonweight bearing; follow-up in three to five days, Short leg walking cast with toe plate or boot for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to six weeks, Open fractures; fracture-dislocations; intra-articular fractures; fractures with displacement or angulation, Short leg walking boot or cast for six weeks; follow-up every two to four weeks; healing time of six weeks, Repeat radiography at one week and again at four to eight weeks, Open fractures; fracture-dislocations; multiple metatarsal fractures; displacement > 3 to 4 mm in the dorsoplantar plane; angulation > 10 in the dorsoplantar plane, Three-view foot series with attention to the oblique view, Compressive dressing; ambulate as tolerated; follow-up in four to seven days, Short leg walking boot for two weeks, with progressive mobility and range of motion as tolerated; follow-up every two to four weeks; healing time of four to eight weeks, Repeat radiography at six to eight weeks to document healing, Displacement > 3 mm; step-off > 1 to 2 mm on the cuboid articular surface; fracture fragment that includes > 60% of the metatarsal-cuboid joint surface, Short leg nonweight-bearing cast for six to eight weeks; cast removal and gradual weight bearing and activity if radiography shows healing at six to eight weeks, or continue immobilization for four more weeks if no evidence of healing; healing time of six to 12 weeks, Repeat radiography at one week for stability and at the six- to eight-week follow-up; if no healing at six to eight weeks, repeat radiography at the 10- to 12-week follow-up, Displacement > 2 mm; 12 weeks of conservative therapy ineffective with nonunion revealed on radiography; athletes or persons with high activity level, Three-view foot series or dedicated phalanx series, Short leg walking boot; ambulate as tolerated; follow-up in seven days, Short leg walking boot or cast with toe plate for two to three weeks, then may progress to rigid-sole shoe for additional three to four weeks; follow-up every two to four weeks; healing time of four to six weeks, Repeat radiography at one week if fracture is intra-articular or required reduction, Fracture-dislocations; displaced intra-articular fractures; nondisplaced intra-articular fractures involving > 25% of the joint; physis (growth plate) fractures, Buddy taping and rigid-sole shoe; ambulate as tolerated; follow-up in one to two weeks, Buddy taping and rigid-sole shoe for four to six weeks; follow-up every two to four weeks; healing time of four to six weeks, Displaced intra-articular fractures; angulation > 20 in dorsoplantar plane; angulation > 10 in the mediolateral plane; rotational deformity > 20; nondisplaced intra-articular fractures involving > 25% of the joint; physis fractures. Advertisement Almost two-thirds of all bones in the feet belong to the toes; hence the risk of fracture in this part of the foot is much higher than the rest of the foot. Flexor and extensor tendons insert at the proximal portions of the middle and distal phalanges. Hallux fractures. The most common phalanx fractures involve the border digits, namely, the index and small finger rays (Fig. Radiographs often are required to distinguish these injuries from toe fractures. Foot Ankle Int, 2015. This content is owned by the AAFP. A walking cast with a toe platform may be necessary in active children and in patients with potentially unstable fractures of the first toe. from the American Academy of Orthopaedic Surgeons, Bruising or discoloration that extends to nearby parts of the foot. The proximal phalanx is the toe bone that is closest to the metatarsals. Nondisplaced acute metatarsal shaft fractures generally heal well without complications. Great toe fractures are generally treated with a short leg walking cast with a toe plate (Figure 1311 ) that extends past the great toe or with a short leg walking boot for two to three weeks.6 After this time, and in the absence of significant symptoms, the patient can progress to buddy taping and use of a rigid-sole shoe for three to four weeks.6,23,24 Range-of-motion exercises can generally be initiated at four weeks. Referral also is recommended for children with first-toe fractures involving the physis.4 These injuries may require internal fixation. Diagnosis is made clinically with the inability to hyperextend the hallux MTP joint without significant pain and the inability to push off with the big toe. Stress fractures are small cracks in the surface of the bone that may extend and become larger over time. Treatment Most broken toes can be treated without surgery. A common complication of toe fractures is persistent pain and a decreased tolerance for activity. The injured toe should be compared with the same toe on the other foot to detect rotational deformity, which can be done by comparing nail bed alignment. If an avulsion fracture results in a large displaced fracture fragment, however, your doctor may need to do an open reduction and internal fixation with plates and/or intramedullary screws. Examination of the metatarsals should include palpation of the metatarsal base, shaft, and head, as well as examination of the proximal tarsometatarsal and distal metatarsophalangeal joints. 2012 Oct; 43 ( 10 ): 1626-32. doi: 10.1016/j.injury.2012.03.010. Copyright 2023 Lineage Medical, Inc. All rights reserved. Minimally displaced (less than 3 mm) fractures of the second to fifth metatarsal shafts (Figure 2) and fractures with less than 10 of dorsoplantar angulation in the absence of other injuries can generally be managed in the same manner as nondisplaced fractures.24,6 Initial management includes immobilization in a posterior splint (Figure 311 ), use of crutches, and avoidance of weight-bearing activities. Adjuvant imaging techniques to analyze fracture geometry and plan implant placement, will be discussed in detail. We help you diagnose your Hand Proximal phalanx case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Physical examination reveals marked tenderness to palpation. Abductor, interosseus, and adductor muscles insert at the proximal aspects of each proximal phalanx. (OBQ09.156) Injury. Stress fractures can occur in toes. Search dates: February and June 2015. He states he has a 30-year-old lumberjack who earlier today was playing softball in the county championship when he slid into home plate in the bottom of the 9th inning. X-rays provide images of dense structures, such as bone. Early surgical management of a Jones fracture allows for an earlier return to activity than nonsurgical management and should be strongly considered for athletes or other highly active persons. Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, He Is Playing With Nonoperative Treatment - Michael Coughlin, MD, He Is Out! A fractured toe may become swollen, tender, and discolored. She is active in ballet and her pain is exacerbated with push-off and en pointe maneuvers. RESULTS: Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. They typically involve the medial base of the proximal phalanx and usually occur in athletes. Spiral fractures often lead to rotation or shortening, and transverse fractures lead to angulation.6. After anesthetizing the toe with ice or a digital block, the physician holds the tip of the toe, applies longitudinal traction, and manipulates the bone fragments into proper position. Thus, this article provides general healing ranges for each fracture. Even with proper healing, your foot may be swollen for several months, and it may be hard to find a comfortable shoe. Most metatarsal fractures can be treated with an initial period of elevation and limited weight bearing. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. Foot radiography is required if there is pain in the midfoot zone and any of the following: bone tenderness at point C (base of the fifth metatarsal) or D (navicular), or inability to bear weight immediately after the injury and at the time of examination.14 When used properly, the Ottawa Ankle and Foot Rules have a sensitivity of 99% and specificity of 58%, with a positive likelihood ratio of 2.4 and a negative likelihood ratio of 0.02 for detecting fractures. It is one of the most common fractures of the foot and has unique characteristics that make it more likely to require surgery. Content is updated monthly with systematic literature reviews and conferences. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5. Most broken toes can be treated without surgery. Kay, R.M. If a fracture is present, it will typically be one of two types: a tuberosity avulsion fracture or a Jones fracture (i.e., proximal fifth metatarsal metadiaphyseal fracture). ClinPediatr (Phila), 2011. Lightly wrap your foot in a soft compressive dressing. Open subtypes (3) Lesser toe fractures. Foot phalanges. Patients usually present with a painful, swollen, ecchymotic toe with variable deformity and gait disturbance. Phalanx fractures: The most common foot fractures Phalanx fractures typically occur by crush injury, hyperextension, or direct axial force (eg, stubbing the toe).