Toe Fractures
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. [5]Associated conditions include nailbed injuries and subungual hematomas.
Diagnosis[edit | edit source]
Radiographs (anteroposterior and oblique) are taken to determine the presence and displacement of the fracture, and to evaluate adjacent areas for injuries. [5]
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 are treated with reduction and buddy taping. [5] When the displaced fracture involves the first toe, referral for stabilisation of the reduction may be needed. [5]
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.
