Toe Fractures: Difference between revisions
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== Clinical presentation == | == Clinical presentation == | ||
Most cases present with tenderness at the fracture site, or pain with axial loading of the toe. <ref name=":2" />Associated conditions include nailbed injuries and subungual hematomas. | Most cases present with tenderness at the fracture site, or pain with axial loading of the toe and ambulation. <ref name=":2" /> <ref name=":3">Bica D, Sprouse RA, Armen J. [https://pubmed.ncbi.nlm.nih.gov/26926612/ Diagnosis and Management of Common Foot Fractures.] Am Fam Physician. 2016 Feb 1;93(3):183-91.</ref>Associated conditions include nailbed injuries and subungual hematomas. | ||
== Diagnosis == | == Diagnosis == | ||
Radiographs (anteroposterior and oblique) are taken to determine the presence and displacement of the fracture, and to evaluate adjacent areas for injuries. <ref name=":2" /> | Radiographs (anteroposterior and oblique) are usually taken to determine the presence and displacement of the fracture, and to evaluate adjacent areas for injuries. <ref name=":2" /> Ultrasonography may also be a useful diagnostic tool. <ref name=":3" /> | ||
== Management == | == Management == | ||
Stable, nondisplaced toe fractures are treated with buddy taping and a rigid-sole shoe to restrict movement and promote tissue healing.<ref name=":2" /> | Stable, nondisplaced toe fractures are treated with buddy taping and a rigid-sole shoe to restrict movement and promote tissue healing.<ref name=":2" /> Displaced fractures of the lesser toes may need reduction before buddy taping. <ref name=":2" /> Treatment is warranted for four to six weeks. <ref name=":3" /> Buddy taping is a well-known method for treating injuries of the toes, especially proximal interphalangeal (PIP) injuries. <ref name=":4">Won SH, Lee S, Chung CY, Lee KM, Sung KH, Kim TG, Choi Y, Lee SH, Kwon DG, Ha JH, Lee SY, Park MS. [https://pubmed.ncbi.nlm.nih.gov/24605186/ Buddy taping: is it a safe method for treatment of finger and toe injuries?] Clin Orthop Surg. 2014 Mar;6(1):26-31.</ref> However, care must be taken to ensure compliance and avoid skin injuries on the adhesive area of the tape.<ref name=":4" /> | ||
When the displaced fracture involves the first toe, referral for stabilisation of the reduction may be needed. <ref name=":2" /> 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.<ref name=":3" /> | |||
== References == | == References == | ||
Revision as of 14:38, 1 August 2023
Introduction[edit | edit source]
Toe fractures are common clinical injuries in children and adults, with studies reporting 14 to 39.6 cases per 10,000 people coming to emergency departments. [1] [2][3] Most toe fractures involve the first and the fifth toe, [3]although fractures of the lesser digits occur much more commonly than the great toe. [2]
Fractures of the toes can be either non-displaced - when the ends of the fracture are still together or displaced - when the fractured bone(s) are partially or completely separated. [4] Most toe fractures are non- or minimally displaced so usually they are treated conservatively. [3]
Mechanisms of injury[edit | edit source]
Toe fractures are usually the result of direct trauma such as crushing from striking objects, [2] [5] axial forces e.g. stubbing a toe, [5] falls, and sports and recreational activity. A sudden abduction force applied to the digit against an object is the most common mechanism of injury. Stubbed toe can occur when flexion of the distal phalanx in conjunction with a proximal shearing force causes a fracture or subluxation.
Indirect trauma such as hyperflexion or hyperextension can also lead to avulsion fractures, but these types of injuries are less common. [5]
Clinical presentation[edit | edit source]
Most cases present with tenderness at the fracture site, or pain with axial loading of the toe and ambulation. [5] [6]Associated conditions include nailbed injuries and subungual hematomas.
Diagnosis[edit | edit source]
Radiographs (anteroposterior and oblique) are usually taken to determine the presence and displacement of the fracture, and to evaluate adjacent areas for injuries. [5] Ultrasonography may also be a useful diagnostic tool. [6]
Management[edit | edit source]
Stable, nondisplaced toe fractures are treated with buddy taping and a rigid-sole shoe to restrict movement and promote tissue healing.[5] Displaced fractures of the lesser toes may need reduction before buddy taping. [5] Treatment is warranted for four to six weeks. [6] Buddy taping is a well-known method for treating injuries of the toes, especially proximal interphalangeal (PIP) injuries. [7] However, care must be taken to ensure compliance and avoid skin injuries on the adhesive area of the tape.[7]
When the displaced fracture involves the first toe, referral for stabilisation of the reduction may be needed. [5] 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.[6]
References[edit | edit source]
- ↑ Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. 2007 Aug;38(8):913-22.
- ↑ 2.0 2.1 2.2 Fife D, Barancik JI. Northeastern Ohio Trauma Study III: incidence of fractures. Ann Emerg Med. 1985 Mar;14(3):244-8.
- ↑ 3.0 3.1 3.2 Van Vliet-Koppert ST, Cakir H, Van Lieshout EM, De Vries MR, Van Der Elst M, Schepers T. Demographics and functional outcome of toe fractures. J Foot Ankle Surg. 2011 May-Jun;50(3):307-10.
- ↑ American Academy of Orthopaedic Surgeons. Toe and Forefoot Fractures. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/toe-and-forefoot-fractures/ [accessed 1/8/2023]
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003 Dec 15;68(12):2413-8.
- ↑ 6.0 6.1 6.2 6.3 Bica D, Sprouse RA, Armen J. Diagnosis and Management of Common Foot Fractures. Am Fam Physician. 2016 Feb 1;93(3):183-91.
- ↑ 7.0 7.1 Won SH, Lee S, Chung CY, Lee KM, Sung KH, Kim TG, Choi Y, Lee SH, Kwon DG, Ha JH, Lee SY, Park MS. Buddy taping: is it a safe method for treatment of finger and toe injuries? Clin Orthop Surg. 2014 Mar;6(1):26-31.
