Toe Fracture
(Redirected from Phalanx Fracture Foot)
Other Names
- Phalanx fracture of the foot
- Digit fracture
- Toe fracture dislocation
- Stubbed toe
- Bedroom fracture
- Nightstand fracture
- Nightwalker fracture
Background
- This page is refers to 'Toe Fractures' or fractures of the Phalanges of the foot
History
Epidemiology
- Prevalence
- Represents about 9% of fractures treated in the primary care setting (need citation)
- About 3% of fractures in children[1]
- Roughly 3.6% of all fracture in adults (need citation)
- Incidence
- Location
- Fractures of the lesser digits (76–83%) is much more common than the great toe (17–24%)[2]
Pathophysiology
- General
- Virtually all toe fractures, especially 2-5, can be treated non surgically
- Stubbed toe
- Occurs with flexion at the distal phalanx in conjunction with a proximally directed shearing force
- Fractures and dorsally subluxes one or both phalangeal condyles
- Toe fractures are often failed to be properly diagnosed, treated due to
- Presence of more serious illness or trauma
- Lack of appropriate clinical training
- Failure to appreciate the integrity of the interphalangeal joints, significance of their range of motion
Mechanism
- Direct trauma
- Direct injuries from striking objects
- Assaults
- Motor vehicle accidents
- Falls
- Recreational and sports activity
- Indirect trauma
- Secondary hyperextension (turf toe)
- Hyperflexion (fall from a height) of the interphalangeal or metatarsophalangeal (MTP) joints
- So-called “bedroom,” “nightstand,” or “nightwalker” fracture,
- Results from a sudden abduction force applied to the fifth digit against a bedpost while walking in the dark
Associated Conditions
Pathoanatomy
- Foot Phalanges
- Proximal, middle and distal phalanges
- 1st toe: two phalanges
- 2nd - 5th toe: generally have 3, although 5th toe may only have two
Risk Factors
- Unknown
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
- Kohlers Disease (Avascular Necrosis of the Navicular)
Clinical Features
- History
- Physical Exam: Physical Exam Foot
- Ecchymosis, edema
- Deformities are rare
- Evaluate the nailbed
- Tenderness to the affected toe
- Special Tests
Evaluation
Radiographs
- Standard Radiographs Foot
- Typically sufficient to make the diagnosis
- Findings
- Most are nondisplaced or minimally displaced
- Comminution is common, especially of distal phalanx
- Displaced spiral fractures generally display shortening or rotation
- Displaced transverse fractures may display angulation
- In children, toe fractures may involve the physis
CT
- Not routinely indicated
- May be needed if multiple foot fractures present
MRI
- Not routinely needed
Classification
- Not applicable
Management
- Goal
- Reestablish osseous alignment
- Maintain normal joint range of motion
Nonoperative
- Indications
- Stable, non-displaced fractures
- General management
- Elevation
- Ice
- Analgesia
- Immobilization
- Rigid Surgical Shoe for 4 to 6 weeks
- Athletic tape, regular walking shoe are not recommended
- Buddy taping or basket weave splinting can be used to reinforce immobilization
- Interdigital support such as cotton, lamb's wool, moldable silicon or felt can prevent maceration
- Pediatric considerations
- Can consider Short Leg Walking Cast with toe plate in active children
- Kids heal more quickly, typically in 3 to 4 weeks
- Weight bearing status
- Non weight bearing status is not usually required
- Consider restricting weight bearing in patients with occupations that include excessive standing, kneeling or walking
- Displaced fractures
- Closed reduction and immobilization should be attempted
- Consider Digital Block to minimize pain
Operative
- Indications
- Open fractures
- Inability to reduce displaced fractures
- Displaced intra-articular fractures
- Unstable, displaced fractures
- Pediatric fractures involving the physis
- Nondisplaced intra-articular fractures involving >25% of the joint space
- Technique
- Open reduction, internal fixation
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Functional outcomes
- Excellent on the AOFAS midfoot score, VAS scoring system in a study by Vliet-Koppert et al[3]
Complications
- Malunion
- Nonunion
- Deformity
- Decreased range of motion
- Foot Osteoarthritis
- Decreased exercise tolerance
See Also
- Internal
- External
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ Rennie, Louise, et al. "The epidemiology of fractures in children." Injury 38.8 (2007): 913-922.
- ↑ 2.0 2.1 Fife, Daniel, and Jerome I. Barancik. "Northeastern Ohio trauma study III: incidence of fractures." Annals of emergency medicine 14.3 (1985): 244-248.
- ↑ 3.0 3.1 Van Vliet-Koppert, Sabine T., et al. "Demographics and functional outcome of toe fractures." The Journal of foot and ankle surgery 50.3 (2011): 307-310.
- ↑ Elleby, D. H., and D. E. Marcinko. "Digital fractures and dislocations. Diagnosis and treatment." Clinics in podiatry 2.2 (1985): 233-245.
- ↑ Venegas, L., J. J. Rainieri, and E. C. Rzonca. "Fracture of the fifth digit. An atypical presentation." Journal of the American Podiatric Medical Association 85.3 (1995): 166-168.
- ↑ Schnaue-Constantouris, Eileen M., et al. "Digital foot trauma: emergency diagnosis and treatment." The Journal of emergency medicine 22.2 (2002): 163-170.