Toe Fractures

Fractures of the toe are often under-diagnosed and under-treated. Comments like "but I could walk on it" and "it's just a toe fracture" represent the cavalier attitude towards toe fractures.  However sometimes toe fractures that are poorly treated and resolved in chronic discomfort and disability.

Toe fractures are a common problem that we see every week.  We use our  feet for almost every single activity and so it is not unusual that they become injured in accidents at home, work and sporting activities. The mechanism of injuries range from falls to crushing injuries. Accidentally kicking something while barefoot is common, just as jumping and landing poorly or stepping in a pothole. Fractures may be open, with the bone sticking out or exposed, or closed.  Fractures may be clean or contaminated. Fractures may be well aligned (nondisplaced) or displaced with rotation or angulation deformities of the toe.  Fractures may be a simple two-part fracture or comminuted with multiple pieces. Toe fractures may involve the joint (intra-articular ) or not(extra-articular).  Every toe fracture is different due to its location, orientation level of comminution.  This is known as the fracture personality. Fractures of the great toe sometimes carry greater significance, due to its importance during pushoff. When a fracture is produced, there is also damage to the surrounding soft tissue, such as the bone covering or periosteum, tendons, ligaments, joints and skin.  Often it is the soft tissue damage and resultant healing with scar tissue that becomes more of a problem after healing.  Treatment of "soft tissue disease" is therefore important as well is treating the bony fracture. The patient who sustained the toe fracture is also important.  Factor such as patient age, general health, nutrition, smoking all affect fracture healing.

Our philosophy is to examine and x-ray all possible toe fractures in order to determine whether a fracture is present, its location and alignment, in order to properly treat the foot injury.  Simple well aligned lesser toe fractures that did not involve the joint may be treated simply with buddy taping of the adjacent toes to provide support and a comfortable large shoe or boot.  Weight-bearing as tolerated he is usually allowed.  nondisplaced fractures that are intra-articular, involving the joint, may require protection and nonweightbearing for 4 to 6 weeks. this protection helps avoid displacement of the fracture with weight-bearing and possible disruption of the joint resulting in chronic arthritis of the toe joint.  Fractures that are displaced with significant malalignment or angulation and fractures involving the joint usually require surgical treatment.  This is especially critical with fractures of they great toe.  At surgery the fracture is aligned, or reduced, and appropriate fixation applied.  In difficult cases, an open incision may be necessary to reduce the fracture (ORIF). fixation may be stainless steel pins, screws or  small plates. afterwards a protective dressing and boot are applied and weight-bearing is restricted for 6 weeks. therapy for range of motion exercises and strengthening is begun after the fracture is healed.  Risks with these fractures and surgical treatment include anesthesia related risks, wound healing problems or infection and stiffness of the toe.