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Broken second toe treatment: Broken Toe Fractures Treatment (Buddy Taping), Symptoms & Healing Time

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Evaluation and Management of Toe Fractures

ROBERT L. HATCH, M.D., M.P.H., and SCOTT HACKING, M.D., University of Florida College of Medicine, Gainesville, Florida

Am Fam Physician. 2003 Dec 15;68(12):2413-2418.

Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe. Joint hyperextension and stress fractures are less common. Most patients have point tenderness at the fracture site or pain with gentle axial loading of the digit. Anteroposterior and oblique radiographs generally are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. Stable, nondisplaced toe fractures should be treated with buddy taping and a rigid-sole shoe to limit joint movement. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. Patients with displaced fractures of the first toe often require referral for stabilization of the reduction.

Toe fractures are one of the most common fractures diagnosed by primary care physicians. In one rural family practice,1 toe fractures comprised 8 percent of 295 fractures diagnosed; in an Air Force family practice residency program,2 they made up 9 percent of 624 fractures treated. Published studies suggest that family physicians can manage most toe fractures with good results.1,2

Anatomy

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). Flexor and extensor tendons insert at the proximal portions of the middle and distal phalanges. These tendons may avulse small fragments of bone from the phalanges; they also can be injured when a toe is fractured. Abductor, interosseus, and adductor muscles insert at the proximal aspects of each proximal phalanx. The pull of these muscles occasionally exacerbates fracture displacement. Sesamoid bones generally are present within flexor tendons in the first toe (Figure 1, top) and are found less commonly in the flexor tendons of other toes. In children, a physis (i.e., cartilaginous growth center) is present in the proximal part of each phalanx (Figure 2).

Differential Diagnosis

The same mechanisms that produce toe fractures may cause a ligament sprain, contusion, dislocation, tendon injury, or other soft tissue injury. Radiographs often are required to distinguish these injuries from toe fractures. Stress fractures can occur in toes. They typically involve the medial base of the proximal phalanx and usually occur in athletes. Stress fractures have a more insidious onset and may not be visible on radiographs for the first two to four weeks after the injury.

History and Physical Findings

Most toe fractures are caused by an axial force (e.g., a stubbed toe) or a crushing injury (e.g., from a falling object). Joint hyperextension, a less common mechanism, may cause spiral or avulsion fractures. Common presenting symptoms include bruising, swelling, and throbbing pain that worsens with a dependent position, although this type of pain also may occur with an isolated subungual hematoma. Although tendon injuries may accompany a toe fracture, they are uncommon.

Physical examination should include assessment of capillary refill; delayed capillary refill may indicate circulatory compromise. The skin should be inspected for open wounds or significant injury that may lead to skin necrosis. The nail should be inspected for subungual hematomas and other nail injuries. Deformity of the digit should be noted; most displaced fractures and dislocations present with visible deformity. Nondisplaced fractures usually are less apparent; however, most patients with toe fractures have point tenderness over the fracture site. The localized tenderness of a contusion may mimic the point tenderness of a fracture. Application of a gentle axial loading force distal to the injury (i.e., compressing the distal phalanx toward the foot) may distinguish contusions from fractures. If this maneuver produces sharp pain in a more proximal phalanx, it suggests a fracture in that phalanx.

Radiographic Findings

Radiographic studies of a toe should include anteroposterior, lateral, and oblique views (Figure 1). A combination of anteroposterior and lateral views may be best to rule out displacement. However, overlying shadows often make the lateral view difficult to interpret (Figure 1, center). In many cases, anteroposterior and oblique views are the most easily interpreted (Figure 1, top and bottom).

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FIGURE 1.

Radiographic series showing spiral fracture of the proximal phalanx of the fourth toe. Note that this patient has an anatomic variant—the fifth toe has only two phalanges. (Left) Antero-posterior view. Angulation, shortening, and slight rotation are visible. Two normal sesamoid bones can be seen beneath the first metatarsal head. (Center) Lateral view. Overlying shadows make it difficult to discern the fourth toe and detect the mildly displaced fracture. (Right) Oblique view. Unlike the lateral view, this view clearly shows the fracture. It also provides another perspective to assess the degree of displacement.


FIGURE 1.

Radiographic series showing spiral fracture of the proximal phalanx of the fourth toe. Note that this patient has an anatomic variant—the fifth toe has only two phalanges. (Left) Antero-posterior view. Angulation, shortening, and slight rotation are visible. Two normal sesamoid bones can be seen beneath the first metatarsal head. (Center) Lateral view. Overlying shadows make it difficult to discern the fourth toe and detect the mildly displaced fracture. (Right) Oblique view. Unlike the lateral view, this view clearly shows the fracture. It also provides another perspective to assess the degree of displacement.

Fractures of the lesser toes are four times as common as fractures of the first toe.3 Most toe fractures are nondisplaced or minimally displaced. Comminution is common, especially with fractures of the distal phalanx. Displaced spiral fractures generally display shortening or rotation, whereas displaced transverse fractures may display angulation. In children, toe fractures may involve the physis (Figure 2).

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FIGURE 2.

Displaced Salter-Harris type II frac ture of the proximal phalanx of a child’s fifth toe Physis can be seen in the proximal aspect of the other phalanges.


FIGURE 2.

Displaced Salter-Harris type II frac ture of the proximal phalanx of a child’s fifth toe Physis can be seen in the proximal aspect of the other phalanges.

Fractures of multiple phalanges are common (Figure 3). Therefore, phalanges and digits adjacent to the fracture must be examined carefully; joint surfaces also must be examined for intra-articular fractures (Figure 3). Patients with intra-articular fractures are more likely to develop long-term complications.

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FIGURE 3.

Nondisplaced transverse fracture of the proximal phalanx of the fourth toe, with a subtle intra-articular fracture of the proximal phalanx of the fifth toe. Without careful scrutiny of adjacent digits, the more problematic intra-articular fracture could be missed.


FIGURE 3.

Nondisplaced transverse fracture of the proximal phalanx of the fourth toe, with a subtle intra-articular fracture of the proximal phalanx of the fifth toe. Without careful scrutiny of adjacent digits, the more problematic intra-articular fracture could be missed.

Indications for Referral

Patients with circulatory compromise require emergency referral. Toe fractures of this type are rare unless there is an open injury or a high-force crushing or shearing injury. Patients with open toe fractures or fractures with overlying skin necrosis are at high risk for osteomyelitis. If there is a break in the skin near the fracture site, the wound should be examined carefully. If the wound communicates with the fracture site, the patient should be referred. In some practice sites, family physicians manage open toe fractures; a discussion about the management of this type of injury can be found elsewhere.3,4 Patients also may require referral because of delayed complications such as osteomyelitis from open fractures, persistent pain after healing, and malunion.

FRACTURES OF THE FIRST TOE

Because of the first toe’s role in weight bearing, balance, and pedal motion, fractures of this toe require referral much more often than other toe fractures. Deformity, decreased range of motion, and degenerative joint disease in this toe can impair a patient’s functional ability.

Referral is recommended for patients with first-toe fracture-dislocations, displaced intra-articular fractures, and unstable displaced fractures (i.e., fractures that spontaneously displace when traction is released following reduction). Referral also is recommended for children with first-toe fractures involving the physis.4 These injuries may require internal fixation.

Referral should be strongly considered for patients with nondisplaced intra-articular fractures involving more than 25 percent of the joint surface (Figure 4).4 These fractures may lose their position during follow-up. Even if the fragments remain nondisplaced, significant degenerative joint disease may develop.4

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FIGURE 4.

Nondisplaced intra-articular fracture of the proximal phalanx of the first toe, with a less obvious, comminuted, nondisplaced fracture of the distal phalanx.

Reprinted with permission from Eiff MP, Hatch R, Calmbach WL. Fracture management for primary care. 2d ed. Philadelphia: Saunders, 2003:354.


FIGURE 4.

Nondisplaced intra-articular fracture of the proximal phalanx of the first toe, with a less obvious, comminuted, nondisplaced fracture of the distal phalanx.

Reprinted with permission from Eiff MP, Hatch R, Calmbach WL. Fracture management for primary care. 2d ed. Philadelphia: Saunders, 2003:354.

Referral also should be considered for patients with other displaced first-toe fractures, unless the physician is comfortable with their management.

FRACTURES OF THE LESSER TOES

Although referral rarely is required for patients with fractures of the lesser toes, referral is recommended for patients with open fractures, fracture-dislocations (Figure 5), displaced intra-articular fractures, and fractures that are difficult to reduce. Referral is recommended for children with fractures involving the physis, except nondisplaced Salter-Harris type I and type II fractures (Figure 6). 4

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FIGURE 5.

Fracture-dislocation of the fifth toe. The proximal phalanx is fractured, and the proximal interphalangeal joint is dislocated.


FIGURE 5.

Fracture-dislocation of the fifth toe. The proximal phalanx is fractured, and the proximal interphalangeal joint is dislocated.


FIGURE 6.

Salter-Harris classification of physeal injuries.

Patients with unstable fractures and nondisplaced, intra-articular fractures of the lesser toes that involve more than 25 percent of the joint surface (Figure 3) usually do not require referral and can be managed using the methods described in this article.

Treatment

STABLE, NONDISPLACED FRACTURES

Patients with closed, stable, nondisplaced fractures can be treated with splinting and a rigid-sole shoe to prevent joint movement. To enhance comfort, some patients prefer to cut out the part of the shoe that overlies the fractured toe. A walking cast with a toe platform may be necessary in active children and in patients with potentially unstable fractures of the first toe.

The preferred splinting technique is to buddy tape the affected toe to an adjacent toe (Figure 7).4 Treatment should continue until point tenderness is resolved, usually at least three weeks (four weeks for fractures of the first toe). Taping may be necessary for up to six weeks if healing is slow or pain persists.

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FIGURE 7.

Buddy taping of the second and third toes. Gauze padding is inserted between the toes to prevent maceration, and nail beds are exposed to avoid concealing rotational deformity.


FIGURE 7.

Buddy taping of the second and third toes. Gauze padding is inserted between the toes to prevent maceration, and nail beds are exposed to avoid concealing rotational deformity.

To control pain and swelling, patients should apply ice and elevate the affected foot for the first few days after the injury. Patients should limit icing to 20 minutes per hour so that soft tissues will not be injured. Non-narcotic analgesics usually provide adequate pain relief. Narcotic analgesics may be necessary in patients with first-toe fractures, multiple fractures, or fractures requiring reduction.

If an acute subungual hematoma is present (less than 24 hours old), decompression may relieve pain substantially. Despite theoretic risks of converting the injury to an open fracture, decompression is recommended by most experts.5 Toenails should not be removed because they act as an external splint in patients with fractures of the distal phalanx.

After the splint is discontinued, the patient should begin gentle range-of-motion (ROM) exercises with the goal of achieving the same ROM as the same toe on the opposite foot. Follow-up radiographs may be taken three to six weeks after the injury, but they generally do not influence treatment and probably are not necessary in nondisplaced toe fractures.

DISPLACED FRACTURES OF LESSER TOES

Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. Although adverse outcomes can occur with toe fractures,3 disability from displaced phalanx fractures is rare.5

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. In most cases, this is done by simply adjusting the direction of traction to correct any shortening, rotation, or malalignment. To unlock fragments, it may be necessary to exaggerate the deformity slightly as traction is applied or to manipulate the fragments with one hand while the other maintains traction. 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. If it does not, rotational deformity should be suspected. Unless it is fairly subtle, rotational deformity should be corrected by further manipulation.

The reduced fracture is splinted with buddy taping. Fracture position ideally will be maintained when traction is released, but in some cases the reduction can be held only with buddy taping. Referral is indicated if buddy taping cannot maintain adequate reduction.

DISPLACED FRACTURES OF THE FIRST TOE

Displaced fractures of the first toe generally are managed similarly to displaced fractures of the lesser toes. To minimize the possibility of future disability, the position of the bone fragments after reduction should be as close to anatomic as possible. If the reduction is unstable (i.e., the position is not maintained after traction is released), splinting should not be used to hold the reduction, and referral is indicated.

To check proper alignment, radiographs should be taken immediately after reduction and again seven to 10 days after the injury (three to five days in children).4 In patients with potentially unstable or intra-articular fractures of the first toe, follow-up radiographs should be taken weekly for two or three weeks to monitor fracture position. At the conclusion of treatment, radiographs should be repeated to document healing.

Complications

A common complication of toe fractures is persistent pain and a decreased tolerance for activity. Pain that persists longer than a few months may indicate malunion, which may limit a patient’s future activities significantly. Toe fractures, especially intra-articular fractures, can result in degenerative joint disease, and osteomyelitis is a potential complication of open fractures.

Broken Toe | Michigan Medicine

Topic Overview

What causes a toe to break (fracture), and what are the symptoms?

You may break one of your toes by stubbing it, dropping something on it, or bending it. A hairline crack (stress fracture) may occur after a sudden increase in activity, such as increased running or walking.

Symptoms of a broken toe may include:

  • A snap or pop at the time of the injury.
  • Pain that is worse when the toe is moved or touched.
  • Swelling and bruising.
  • Possible deformity (not just swelling), such as a toe pointing in the wrong direction or that is twisted out of normal position. A dislocated toe can also look deformed.
  • Decreased movement or movement that causes pain.

How is a broken toe diagnosed?

A broken toe is diagnosed through a physical examination. Your health professional will look for swelling, purple or black and blue spots, and tenderness. An X-ray may be needed to determine whether the toe is broken or dislocated.

How is it treated?

Home care after breaking a toe includes applying ice, elevating the foot, and rest. Medical treatment for a broken toe depends on which toe is broken, where in the toe the break is, and the severity of the break. If you do not have diabetes or peripheral arterial disease, your toe can be “buddy-taped” to your uninjured toe next to it. Protect the skin by putting some soft padding, such as felt or foam, between your toes before you tape them together. Your injured toe may need to be buddy-taped for 2 to 4 weeks to heal. If your injured toe hurts more after buddy taping it, remove the tape.

In rare cases, other treatment may be needed, including:

  • Protecting the toe from additional injury. This may include using splints to stabilize the toe, a short leg cast, or a brace.
  • Surgery, if the break is severe.

Medical treatment is needed more often for a broken big toe than for the other toes. An untreated fracture may cause long-term pain, limited movement, and deformity.

Credits

Current as of:
November 16, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
H. Michael O’Connor MD – Emergency Medicine
Gavin W.G. Chalmers DPM – Podiatry and Podiatric Surgery

Current as of: November 16, 2020

Author:
Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & H. Michael O’Connor MD – Emergency Medicine & Gavin W.G. Chalmers DPM – Podiatry and Podiatric Surgery

Common Symptoms and Treatment of a Fractured Toe

Toe injuries due to dropping something on it or stubbing a toe are common, but many people wonder how to tell if the toe is broken, sprained, or just bruised. It can be tempting to ignore an injured toe, but you’re at risk of improper healing that can impair your ability to participate in regular activities without pain for a long time. Fortunately, if the toe is broken, a foot and ankle orthopedic surgeon in Atlanta can help treat your toe. Here are the symptoms of a broken toe as well as how it should be treated.

Symptoms of a Break

The symptoms of a broken toe are very similar to that of a bad sprain. There will be swelling and bruising on and around the toe. As with a sprain, you’ll have difficulty putting weight on the foot if you have a broken toe. If the break is severe, you’ll probably be able to tell that the toe is broken because of the unnatural angle of the toe. You may have even heard a breaking sound when the injury occurred. If you originally suspect the toe is just sprained, you may wait a few days to see a doctor. If this is the case, the pain won’t subside after a few days like it will with a sprain. The only way to determine if the toe is broken is to see a doctor who will usually order an x-ray. 

Importance of Seeing a Doctor

Many people dismiss the seriousness of a broken toe because they assume there’s not much an orthopedic foot specialist in Atlanta can do about a broken toe. However, ignoring a broken toe can lead to a chronic, painful condition called osteoarthritis, which causes pain in the joints. In addition to future problems from the broken toe itself, you may have sustained nerve damage, especially if you have tingling or numbness in your toe. Visiting the doctor can help assess the severity of the break to determine what course of treatment will be best.

Treating a Broken Toe

If a toe isn’t seriously broken, it will heal on its own without much intervention from the doctor. You can ice the toe, keep it elevated, and take over-the-counter pain relievers while the toe heals. However, in more serious breaks, the doctor may recommend splinting the toe by taping the broken toe to the adjacent toe with medical tape to keep the toe from moving while it heals. A very serious break may require an orthopedic surgeon to perform surgery to reset the broken bone. Sometimes, a permanent pin is placed in the bone to ensure it heals properly. With a broken toe, it’s important to allow yourself time for the toe to fully heal. Returning to regular activity too soon will prolong healing time and possibly cause more damage.

Toe And Metatarsal Fractures (Broken Toes) – Podiatrist in Muskegon, MI

The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).

Signs and symptoms of a traumatic fracture include:

  • You may hear a sound at the time of the break.
  • “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
  • Crooked or abnormal appearance of the toe.
  • Bruising and swelling the next day.
  • It is not true that “if you can walk on it, it’s not broken.” Evaluation by a foot and ankle surgeon is always recommended.

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.

Symptoms of stress fractures include:

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • “Pinpoint pain” (pain at the site of the fracture) when touched
  • Swelling, but no bruising

Consequences of Improper Treatment
Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

  • A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
  • Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
  • Chronic pain and deformity
  • Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

  • Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
  • Splinting. The toe may be fitted with a splint to keep it in a fixed position.
  • Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
  • “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
  • Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.

Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.

Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:

  • Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
  • Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
  • Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
  • Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
  • Follow-up care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.

For more information on broken toes, listen to the Broken Toes podcast. 

Phalangeal Fracture | Country Foot Care


Like the old song says, “There must be fifty ways to…” – break your toe! Stubbing it on the bedpost, kicking a ball, tripping on a root, falling down the stairs, landing hard while dancing, dropping a barbell on it – any one of these can harm the bones (phalanges) in your toes and cause a phalangeal fracture. Our toes are a complex set of bones, ligaments, tendons and muscles, and they are used for so many of our movements that harming them almost seems inevitable. A broken toe may be hardly noticeable, or it could really leave you hobbling, depending on how severe the break is.

Is My Toe Broken?

Sometimes it is hard to tell the difference between a bruise, a sprain, and a break. Pain, swelling, bruising and stiffness might be present with all three, but if it hurts to put even a little weight on it, or the toe has an odd bump or looks a funny shape, it is more likely to be broken. Complications from a broken toe could be immediate (like difficulty putting on shoes or walking, or pooled blood under a toenail) or they could develop over time (like the bones not healing properly or arthritis forming in them).

Quick Action for a Fracture

Here’s what to do if you’ve injured your toe. First, take pressure off the toe and rest it. Next, ice and elevate it to reduce swelling and pain. If the skin is pierced and the bone is showing through, it is a medical emergency. You will want to have the experts at Country Foot Care on Long Island take a look at it right away. The same is true if the toe feels numb or cold, if there is drainage or bleeding in the area, or if the skin color is blue or gray. Third, if it seems a minor injury, keep off it and watch for a day or so to see if it starts to improve. If not, come and see us so we can determine the extent of the injury or fracture.

How We Treat Toe Fractures

A simple fracture may need only rest and time to heal. If necessary, we may buddy tape it to its neighboring toe to keep it stable, or use a splint until it heals. For more serious breaks, the toe may have to be put back into position and a cast applied. In some cases, the bones are so damaged that only surgery will enable them to heal correctly without causing long term problems.  A toe fracture can take 6 weeks to heal, and we may want to check it during that time to make sure all is going well.

Country Foot Care has offices in New York, which offer state-of-the-art foot care in a boutique setting. Call us at 516-741-FEET (3338) and let us pamper you and put you on the road to recovery! Visit our online contact page to request an appointment today.

Here’s What Happens When you Don’t Treat a Broken Toe

You may have heard one of the many myths surrounding broken toes: that it will heal on its own, or that it’s okay as long as you can still walk on it. While reassuring, these common misconceptions are entirely false, and can have potentially severe consequences. Leaving a broken toe untreated can result in various complications, from misaligned bones and infection to arthritis and permanent foot pain. The thought of a doctor visit or hospital bill may make you cringe at first, but your feet will thank you for it in the long run.

Here is a look at the signs that your toe is broken, the dangers of avoiding treatment, and the steps you need to take to make sure your toe heals properly.

Signs Your Toe Is Broken

Even the smallest of accidents can result in toe trauma: dropping an object on the foot or stubbing your toe are common misfortunes that often lead to injury. Moreover, repetitive trauma to the toe over time can result in a stress fracture. While it’s tempting to try to tough it out, it’s important to listen to your pain to identify whether or not your toe is fractured.

It usually requires significant force to break a bone, although a little less so for the toes since their bones are so small. Regardless, the instance of fracture will be extremely painful. The toe will begin to swell as the fractured bone bleeds, resulting in bruising as the blood reaches the skin. You may also see blood pool beneath the toenail. In many cases an injury to the toe also involves damage to the toenail, which further increases your risk of infection should the toenail expose the tissue underneath. The fracture usually makes it extremely painful to walk, although this is not always the case. Even if you can still manage to walk on the toe, that doesn’t eliminate the possibility of a fracture.

Seek prompt medical attention if your toe shows signs of:

  • Swelling
  • Pain
  • Bruising, or blue or gray spots surrounding the site of trauma
  • Stiffness
  • Trouble Walking
  • Deformity
  • Infection
  • Bleeding, especially beneath the toenail
  • Coldness, numbness, or a tingling sensation indicative of nerve damage
Complications of an Untreated Broken Toe

Leaving a broken toe untreated can have serious and long term complications, including, but not limited to:

  • Infection: If the injury has left an open wound, or especially if there is damage to the toenail, you are at risk of contracting an infection. Any exposure of a broken bone can lead to a bone infection (osteomyelitis), which is usually caused by the bacteria staphylococcus aureus. Once diagnosed, your doctor may implement antibiotics straight into the bloodstream intravenously, or you may need to take medication for up to six weeks. If the infection is severe, your doctor may have to perform surgery to remove the infected bone.
  • Compound fracture: A compound fracture is when a broken bone penetrates the skin, leaving the bone vulnerable to infection.
  • Deformity: An untreated broken toe has a high likelihood of healing incompletely or improperly, potentially resulting in crookedness or deformity which may require corrective surgery down the road.
  • Osteoarthritis: An improperly healed fracture can lead to a future of osteoarthritis as you age, generalized foot pain and discomfort, as well as an increased likelihood of further foot injury.
Toe Fracture Diagnosis and Treatment

Your podiatrist will order an X-ray to confirm a toe fracture. Once properly diagnosed, a mild toe fracture can be treated at home under the guidance of your trusted podiatrist. Home treatment essentials include elevating the foot above the level of the heart in order to decrease swelling, icing the injury for 20 minutes every 2 hours for the first 2 days, and of course rest and crutches to avoid bearing weight on the injury while you recover. OTC acetaminophen or ibuprofen should be sufficient for coping with the pain, although your doctor may prescribe a stronger medication if your fracture is severe.

If the fracture is minor or located in one of the small toes, your doctor may simply implement buddy taping, which involves taping the damaged toe to its neighbor for support while it heals. In cases where the toe fracture becomes rotated or displaced, the doctor will need to perform a reduction. This involves administering a shot of local anesthesia before realigning the toe back into its proper position.

Casting may be required in more severe fractures: where the big toe is injured, the joint is damaged, the injury involves various small toe fractures at once, or if a bone in the foot is injured in addition to the fractured toe. When wearing a cast, a sturdy shoe should be worn to provide maximum comfort and support. If all goes well, the fracture should take up to six weeks to heal.

Schedule a Consultation with Dr. Vikki and Dr. Connie

If you have suffered injury to your feet, toes, or ankles, don’t wait for complications to arise.Schedule a consultation with trusted podiatrists Dr. Vikki and Dr. Connie at the Superior Foot & Ankle Care Center today.

Toe Fracture in Children – What You Need to Know

  1. CareNotes
  2. Toe Fracture in Children

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is a toe fracture?

A toe fracture is a break in a bone in your child’s toe.

What are the signs and symptoms of a toe fracture?

  • Pain, redness, swelling, or bruising
  • Not being able to bend or move the toe
  • Not being able to walk or put weight on the toe
  • Toe is bent at an angle that is not normal

How is a toe fracture diagnosed?

Your child’s healthcare provider will examine your child and ask about the injury. Your child may also need any of the following:

  • An x-ray may show a toe fracture.
  • A MRI may show a stress fracture or ligament damage. Your child may be given contrast liquid to help an injury show up better in pictures. Tell a healthcare provider if your child has ever had an allergic reaction to contrast liquid. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell a healthcare provider if your child has any metal in or on his or her body.

How is a toe fracture treated?

  • Buddy tape, an elastic bandage, or a splint may be used to support your child’s toe in its correct position. Buddy tape means the fractured toe and the toe next to it are taped together.
  • A support device such as a cane, crutches, walking boot, or hard-soled shoe may be needed. These help protect your child’s broken toe and limit movement so it can heal.
  • Medicines may be given to prevent or treat pain or a bacterial infection.
  • Closed reduction is used to move your child’s bones back into place without surgery.
  • Surgery may be needed for a more severe break. Wires, pins, or other hardware may be used to keep the bone in place while it heals.

How can I help manage my child’s symptoms?

  • Help your child rest so the toe can heal. He or she can return to normal activities as directed.
  • Apply ice on your child’s toe for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Elevate your child’s toe above the level of the heart as often as you can. This will help decrease swelling and pain. Prop your child’s toe on pillows or blankets to keep it elevated comfortably.

When should I seek immediate care?

  • Your child has severe pain in his or her toe.
  • Your child’s toe is cold or numb.

When should I call my child’s doctor?

  • Your child has a fever.
  • Your child’s pain does not go away, even after treatment.
  • Your child’s toe continues to hurt even after it has healed.
  • You have questions or concerns about your child’s condition or care.

Care Agreement

You have the right to help plan your child’s care. Learn about your child’s health condition and how it may be treated. Discuss treatment options with your child’s healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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90,000 risk factors, clinical presentation, treatment principles and possible complications

In this article, we will introduce you to the types, manifestations, methods of first aid, diagnosis and treatment of fractures of the toes. This information will be useful for you, and you will be able to suspect the presence of such an injury in time, correctly provide first aid to the victim and make an adequate decision on the need for treatment by a specialist.

Classification of fractures of the toe

Closed fractures are the most common.In this case, the integrity of the skin is preserved. Compression injury is often accompanied by displacement. An open comminuted fracture is difficult to repair. But much is determined by the location of the damage. In this regard, allocate:

  • Fracture of the big toe of the leg – often accompanied by a fracture of the sesamoid bone. Intra-articular lesions most difficult to treat,
  • fracture of the index finger – involves damage to one or more phalanges of the fingers,
  • fracture of the middle finger – the nail phalanx suffers more often, and along the fracture line the fracture can be oblique, longitudinal or transverse,
  • Fracture of the ring finger – a single injury is rare, very often injuries also affect the little finger.There are also simultaneous injuries of 1,2 and 4,5 fingers,
  • Fracture of the little toe – One of the most common injuries is a fracture of the proximal phalanx.

Damage without displacement heals faster, and medical reduction is not required. It is much harder in case of significant deformations. At the same time, there are several types of displacements:

  • with divergence and overlapping,
  • lateral and angular offset,
  • with wedging of fragments.

In case of damage to the middle and distal phalanx, the treatment tactics will be the same, although the damage itself occurs in different ways. Only a punctured fracture of the toes can cause a fracture of the middle phalanx. It is quite difficult to damage it if dropped or hit.

Fractures of phalanges

Swelling occurs at the site of injury. A blow to the big toe causes similar disturbances as with a thumb injury, due to the presence of only two phalanges.Phalangeal fractures are divided into T-shaped, oblique and transverse. A direct impact on the fifth toe causes multiple injuries due to the small size of the phalanges. The affected little finger instantly swells and becomes cyanotic.

ICD trauma code 10

Code S92 covers all foot fractures. With an injury such as a broken little finger, a separate code is not assigned, but with a thumb injury, the code S92 is prescribed in the card. 4. In case of a complex fracture with multiple injuries of the foot, the disease is designated by the code S92.7. All fractures of any toe other than the thumb are covered by code S92.5.

Reasons

Injuries caused by bone pathologies occur only in 5% of cases from general fractures. As a result of this injury, the integrity of the group of bones is disrupted, and recovery is extremely difficult. So, if the phalanx of the little finger is damaged, cracks in the metatarsus are often observed. A minor blow to another object can cause such pathologies. It is enough to step on a person’s foot to provoke injury.

Symptoms

What are the first signs of a toe fracture? First of all, it is intense pain. It increases with tapping or palpation. Pain shock does not occur. Even in the event of a serious injury, pain can be tolerated.

Hematoma in the area of ​​the fracture indicates a rupture of blood vessels. In some cases, the leg becomes literally purple. Puffiness after a fracture often occurs with severe bruising and damage to soft tissues.

If there are wounds, then we are talking about an open injury.Skin lesions often accompany symptoms of a fractured or cracked big toe. Other signs of a toe fracture are:

  • redness and local hyperthermia,
  • enlargement of the damaged finger in size,
  • restriction of mobility or complete immobilization.

Symptoms of a fractured toe may include shortening of the injured toe and its abnormal mobility. In case of bone crushing, the fragments can be seen with the naked eye.Signs of a fractured little toe include a deformity of the foot and a possible deeper shift of the fifth toe. The characteristic symptoms of a fracture of the little toe include crepitus of bones or bone fragments.

First aid

In this case, the procedure will be as follows:

  • Give the patient an anesthetic,
  • treat the wound, if any,
  • fix the damaged pin.

If the pain syndrome does not decrease, then non-narcotic analgesics are suggested.Immobilization should be done if displacement is suspected. You can fix your toe with a bandage and splint.

Usually the thumb is immobilized. It is wrapped with a pencil or other solid and suitable object. Fixation is not always justified.

More often than not, the patient is simply laid or seated, and the leg is placed on a dais.

If the main phalanx of 4 fingers is damaged, then you can fix the finger with the adjacent one. It is impossible to tie the phalanges tightly, a cotton pad is placed between them.

Cold will help relieve pain and swelling. A bag of crushed ice is applied for 5-10 minutes, and then a break is taken to avoid frostbite.

Cooling will help if there is a fracture of the little toe, but for this damage, first aid will be slightly different.

What to do if the little toe is broken

In case of injury to the little toe, the leg must be lifted up and placed on a pillow in a relaxed position. This will prevent swelling and swelling of the soft tissues.Little finger immobilization is not required, but the foot must be secured to bring the victim to the hospital. Shoes are not worn, otherwise the chipped bones may be displaced.

What else to do in case of a broken toe at home? After carrying out anesthetic and anti-inflammatory therapy, it remains only to call an ambulance. Without an accurate diagnosis, it is difficult to take further action. It is forbidden to adjust your finger yourself.

Diagnostics

If the second and further fingers are damaged, the patient may not be aware of the fracture.Often the symptoms are similar to a common bruise. How to identify a fractured toe without X-ray?

An experienced physician will be able to understand the nature of damage during palpation and tapping. However, it is not always possible to recognize complex wounds visually. You can find out the crack using CT. But this method looks redundant and unjustified when the damage is obvious.

Treatment

If the broken little fingers on the leg are displaced, then they are set. How to treat a fracture in the event of a closed injury? The method of one-step reduction is usually used.

Treatment of a toe fracture begins with anesthesia, after which the toe is gradually extended, returning it to its physiological position. After the adjustment, the functionality of all fingers is checked. If the swelling goes away and the fingers are functioning properly, install the retainer. This is usually a cast, but there may be a bandage.

The timing of immobilization of the phalanges of the toes is determined by the severity of the injury. For minor injuries, a thumb brace can reduce stress and protect the foot from external influences.

If the fracture cannot be cured with a one-stage closed reduction, skeletal traction is used. It is an invasive restoration method that keeps the bone fragments in the correct position.

The damaged little finger (or other finger) is pierced and a nylon thread is inserted. If the little toe is broken, you can fix it with special pins. In adults, fusion takes several weeks, in children – less.

The puncture site is treated with antiseptics, and after removing the retainer, orthosis is installed on the finger.

It makes no sense to use folk remedies for fracture. The exception is phytopreparations with decongestant, anti-inflammatory and analgesic effects. But they are used for short-term treatment. Products with gelatin content – jelly and jellied meat allow to speed up the process of accretion.

Operative treatment

Despite the surgical precision in open surgery, there are many difficulties that arise from the specifics of the therapy.The risk of infection and suppuration remains high, and it may be difficult to administer anesthesia.

How much to treat and wear plaster

How to quickly heal a damaged foot and shorten the duration of fracture treatment? Much is determined by the individual characteristics of the patient’s body and the specifics of the injuries themselves. After open reduction, the bones grow together for a long time. Whether a plaster cast is needed after the main treatment is determined by the traumatologist. But no reduction is complete without additional commit.

You will have to wear a plaster cast as long as a finger fracture heals. With cracks and minor fractures of the toes, immobilization lasts up to 3 weeks.

In case of displacement, you can walk no earlier than after 4 weeks, and sometimes after 6 weeks. How much a finger fracture heals in the case of an open wound depends on the complexity of the operation. Plaster is usually prescribed for a period of 5-6 weeks.

Disability recovery takes up to 2 months if complications have occurred.

In the event of an incorrect splice, a second operation will be required. It’s hard to say how long the recovery will take. Usually the period of incapacity for work is doubled.

Rehabilitation

The patient is recommended to start exercise therapy immediately after removing the plaster. One effective exercise is fingering small objects with your toes. Such gymnastics will be especially useful if nerves have been damaged due to injury. Overvoltage during training should not be.First, they train for 15-20 minutes, over time, the duration of the classes is increased to 40-60 minutes.

Physiotherapy

Exercises after a toe fracture involve squeezing and straightening all toes. The injured finger is not used for some time, but then it is also connected to gymnastics.

At the first stage, it is better to replace the exercises with self-massage. Light stroking and squeezing will improve blood flow and prevent atrophy. There should be no unpleasant sensations during gymnastics.

Duration of therapy – no more than 10 minutes, course duration – 10-15 procedures.

You can develop a foot on your own, but before doing massage and gymnastics, you should consult a doctor. If the fracture of the toe heals slowly, then hardware physiotherapy is prescribed. The following treatments have proven effective:

  • UHF-therapy – reduces pain syndrome, improves tissue trophism, stimulates metabolism and capillary blood circulation.One of the most reliable methods of recovery after fractures,
  • magnetotherapy – accelerates regeneration, prevents the development of diseases of the skeletal system, reduces edema,
  • interference currents – activate trophic processes, relieve hematomas, normalize blood circulation.

Ozokerite applications have useful properties. They dilate blood vessels and eliminate pain after a long stay in one position. Salt baths have a similar effect.Soda baths will prevent complications and the development of callus. They eliminate local inflammatory reactions and reduce post-traumatic edema.

Complications and consequences

Negative consequences arise from the lack of treatment. Many patients simply do not go to the doctor, because the injury does not bother them much. But this is at first. Over time, the deformities become irreversible, and the foot does not function properly.

Complications can arise from errors in therapy. If a fracture of the phalanx of one of the toes does not heal properly, a callus may form. This is an abnormal tissue at the fusion site. Its size sometimes exceeds the size of the phalanx.

The growth of replacement tissue is due to the weakness of the bone structure. Callus compensates for the lack of strength, but it causes great inconvenience to the patient. It causes pain, interferes with walking, complicates the selection of shoes.

In addition, it is always an additional source of inflammation and a vulnerable spot in the event of injury.

If the callus is formed due to improper reduction, then a second operation is required. In this case, healing will take longer than usual. In the presence of a bone defect, repeated surgery is associated with the risk of tissue inflammation.

Other complications of toe fractures are also distinguished:

  • False joint – occurs due to shrapnel damage. The scattered fragments are erased and become separate elements of the bone. They are not connected with each other, and the space between them is the same false joint.Due to the absence of cartilage tissue, an inflammatory process occurs between the fragments. The functionality of the toe and foot is generally reduced. If the upper phalanx is damaged, then nail ingrowth is possible,
  • ankylosis – occurs due to inflammation in damaged tissues. Over time, the joints become ossified and lose their mobility. This is one of the reasons why toes go numb. Sometimes they are completely immobilized, which leads to tissue death. Prosthetics are used to get rid of this defect,
  • Osteomyelitis is one of the most dangerous complications.It occurs as a result of improper treatment of an open fracture. Pathogenic microorganisms enter the bone and cause inflammation. The infection enters the body through an open wound. Less often – by hematogenous route. Correct initial treatment of damage will prevent the development of osteomyelitis. If it is not possible to avoid infection, powerful antibiotic therapy is used. In advanced cases – depressurization of the bone,
  • shortening of the bone – is the result of improper fusion. Incorrect reduction followed by immobilization firmly fix the fragments in the wrong position.The support function of the bone decreases, and pain occurs during movement. The risk of re-fracture increases dramatically. The next reduction will help to correct the situation, but the fragility of the damaged bone is still preserved.

Prevention

In case of weakening of the skeletal system, calcium preparations are prescribed. They are recommended for prophylaxis for all elderly people, women during and after menopause, as well as pregnant and lactating women.

From a medical point of view, the best prevention is increased caution on the street and at home.Avoiding a fracture of the main phalanx is easy if you look under your feet and prevent injury.

Products enriched with calcium, magnesium, vitamin D will help to strengthen bones. This group includes fermented milk products, egg yolks, nuts, chicken liver, seafood, olive oil. They also prevent diseases such as arthritis and arthrosis. At the same time, you should limit the intake of oxalic and uric acids.

Source: https: //xn--h2aeegmc7b.xn--p1ai/pervaya-pomoshh/perelomyi/perelom-paltsa-na-noge

3 symptoms (signs) of a broken toe – how to understand that it is broken

Fracture of a toe is one of the many and especially widespread types of injuries sustained by a person in everyday life.

To obtain such a serious mechanical damage to the bone tissue, it is enough to apply insignificant efforts. A bruise, an unsuccessful jump, a fall on the leg of even a small object, as well as many other reasons can lead to a fracture.

It should be emphasized that for persons suffering from various forms of diseases leading to pathological fragility of bones, it is rather unfortunate enough to distribute the weight of their own body on the toes.

An important point is the provision of timely assistance to the victim.

Failure to do so can lead to serious consequences, including loss of flexibility and mobility of the fingers, constant pain, and in severe cases, tissue necrosis.

Classification

The term “fracture” refers to the violation of the integrity of the bone tissue, namely the phalanges of the toes, due to the application of an action, the force of which is many times greater than the resistance of the damaged segment. In direct proportion to the nature and type of the injury received, there are several options for classifying fractures of the toes.

Mainly, injuries to the toes are divided into closed and open. In the latter case, a kind of application to the resulting injury is a violation of the integrity of the skin, which arose as a result of the displacement of bone fragments.

In case of fractures with displacement of individual fragments of bone fragments, this type of injury is subdivided into splinter-free, one or two-splinter, and also multi-splinter. As the name suggests, the determining factor is the presence and total number of chipped segments of the damaged phalanx of the toes.

In addition, bone fractures are classified accordingly with an injured phalanx. In this case, damage to the big toe is isolated as a separate subspecies, which is due to some difference in its anatomical structure, which consists in the presence of only two phalanges.

Reasons

As mentioned above, numerous factors can cause a leg fracture, including unsuccessful falls, bruises, improper distribution of the load on the toes, as well as other factors of a similar nature.However, regardless of the reason that provoked the injury, it is recommended that everyone know what to do in case of a toe fracture and how to provide first aid to the victim.

Symptoms

Symptoms and signs of a toe fracture may vary somewhat in direct proportion to the nature of the injury. In this case, the first manifestations of the fracture are especially acute, some time after receiving mechanical damage, the clinical picture becomes somewhat blurred. The general symptomatology is as follows:

  • The predominant signs of a violation of the integrity of the bone tissues of the toes are pain and sensations of pulsation in the area of ​​the injured area. At the same time, depending on the nature of the injury, painful sensations can spread to the entire leg or be localized in the immediate vicinity of the damaged phalanx.
  • The appearance of tissue edema or bruising, which is the result of damage not only to bone segments, but also to the skin or blood vessels.
  • In displaced fractures, the deformity of the injured toe can also be seen with the naked eye. In this case, with open forms of mechanical damage, open wound surfaces may appear.

Unlike other types of injuries, such as bruises, symptoms of a broken toe do not fade even after several hours. Moreover, painful sensations can persist for a long period of time, even if the patient is provided with medical assistance.

First aid

In order to provide first aid to the victim, you need to know how to determine if a toe is broken. First of all, long-term pain that does not go away speaks of receiving this injury. In addition, the spread of pain to the entire foot may indicate a fracture. If there is a suspicion of a fracture, you must:

  • First aid for a fractured toe is to numb the affected area.This can be done with drugs for local or internal use.
  • Next, you should immobilize or, simply put, fix the damaged segment using any homemade splint and sterile bandage. In the presence of open wound surfaces, the wound should be disinfected.

And, of course, an urgent measure of help is contacting a medical institution.

Diagnostics

When an injury is received, the question of how to determine a fracture of a toe becomes relevant.The determining factor in this case is long-term pain syndrome. However, trying to diagnose at home is still not worth it. To determine a fracture, you should definitely consult a doctor.

Among the many diagnostic methods, radiography is especially often used to detect the presence of damage. In severe cases, for example, against the background of numerous fragments, it is possible to use computed tomography. This examination provides more detailed images of the injured toe.

Treatment

The process of treating broken toes is similar to that used for injuries to the arms, legs or any other elements of the bone skeleton. To determine the most suitable option for conservative therapy, it is required to carry out diagnostic procedures, the main purpose of which is to determine the type, severity of the injury received.

Emergency help

If your little finger or any other finger is broken, you should not ask yourself questions about what to do, it is important to seek help from a medical facility as soon as possible. Before the arrival of an ambulance, you can give the patient any pain medication.

Emergency medical care primarily consists of the use of anesthetic drugs that will help relieve intense pain. Further, after carrying out diagnostic measures, it is necessary to immobilize the injured finger, the essence of which is to apply a plaster cast, fixing the broken finger in the anatomically correct position.

A few days after the application of the splint, the patient needs to visit a specialist again for a second study, which will reveal the dynamics of bone tissue healing, the presence or absence of complications, and assess the process of bone fusion as a whole.If the bone is properly healed, the immobilizing dressings are removed four to eight weeks after injury.

Fracture of thumb and middle toe

Fractures of the big or middle toe occupy a separate place in the general list of injuries. This is due to intense painful sensations, the appearance of which is characterized by such damage.

The treatment tactics used in this case does not differ significantly from the methods used for other types of fractures. The only thing that should be paid attention to is the timely provision of assistance to the patient, which consists in the introduction of anesthetic drugs.

The absence of such against the background of a low pain threshold can lead to the development of a shock state in the patient.

Multiple fracture

On the background of multiple fractures of the toes, it is possible to apply a general fixation bandage on the entire surface of the injured leg. This measure allows you to exclude possible displacement of bone fragments and prevent possible complications. This is the most common approach for fractures of the little finger and ring fingers.

A separate point is in this case the nature of the injuries received. In the event that the extreme phalanges of the toes were subject to damage, the application of an elastic patch is sufficient to fix them, which reliably holds the fingers in the anatomically correct position even when the thumb moves.

Compound fracture with displacement

For complex fractures associated with displacement of bone segments or the formation of several fragments, an invasive method of treatment is used. There are two options for surgical intervention, each of which is used only according to the doctor’s prescription:

  • Metal plate. The essence of this procedure is as follows: during surgical manipulations, individual bone segments of the injured toe are tightly attached to a thin metal plate, which is a kind of frame. A foreign object is removed only after complete healing of bone tissue and the formation of a callus.
  • Metal spoke. This method is classified as sparing, since the removal of the wire is not painful and does not require the use of general anesthesia. This procedure involves drilling individual fragments of the damaged leg bone, followed by stringing them onto a thin metal knitting needle. After the damaged tissue is restored, the fixing object is simply pulled out and removed.

Open fracture

Due to the absence of large blood vessels, even open forms of finger fractures are not potentially hazardous to the health and life of the victim. However, due to the formation of an open wound surface, treatment is still required.

Initially, the wound is treated with a disinfectant antibacterial preparation. Further, bone fragments of the damaged phalanx of the finger are fixed in the anatomically correct position. Metal needles or plates can be used for this procedure.

After this procedure, sutures or a sterile bandage are applied to fix the damaged skin.The length of the recovery period can vary significantly depending on the severity of the injury.

Recovery period

After removing any fixing bandage, including plaster, the patient needs a certain time to restore the functional features of the injured leg.

The need for rehabilitation is due to the fact that when the injured limb is in the immobilizing bandage, the muscle tissue loses its elasticity and becomes less mobile.

For the development of muscles and strengthening of bone tissues, patients are recommended such methods of treatment as physiotherapy exercises, massage, methods of physiotherapy, adherence to a diet with a high content of vitamins, microelements, moderate physical activity.

Application of these techniques on a regular basis will allow to normalize, stabilize the condition of the affected finger and limb, prevent possible complications, and quickly return to the previous full life.

Source: https://SkeletOpora.ru/travmy-kolenej/perelom-paltsa-na-noge

Signs of a toe fracture, treatment

Fractures of toes are common in the practice of traumatologists and no one is immune from their occurrence. You can get such an injury even with a banal blow of your leg against a corner, furniture, or when you twist your leg.

In 95% of cases, toes break due to traumatic causes – impact or compression.However, sometimes such injuries occur due to pathological factors – osteoporosis, osteomyelitis, neoplasms or bone tuberculosis. These diseases cause destruction of the bone, and even a minimal mechanical effect on it can cause its fracture.

According to statistics, fractures of the toes account for 5% of all fractures, and in case of leg injuries, every third patient of a traumatologist is diagnosed.

As a rule, they respond well to treatment and there is a misconception among the population that such fractures are simple and can heal on their own without the participation of a specialist.

However, the lack of qualified and timely treatment can lead to the development of many complications, which will subsequently cause more inconvenience than the injury itself.

Classification

Fractures of the toes can be open or closed. Most often, such injuries are not accompanied by damage to the skin.

In most cases, toe fractures are not accompanied by damage to the skin, that is, they are closed.

By the presence of displacement, open and closed fractures of the toes can be:

  • with offset;
  • no offset.

Fractures of the toes with displacement can be:

  • angular offset;
  • with wedging;
  • with side shift;
  • with longitudinal divergence;
  • with longitudinal engagement.

Angular displacement of fragments of the phalanges often occurs in children and is rarely observed.This fact is explained by the fact that at this age the periosteum remains elastic and may not be damaged by mechanical stress. In such cases, the broken bone is not completely held on it, and the fragment is displaced in the direction opposite to the fracture line.

The wedging of fragments in fractures of the toes is detected in 1 / 4-1 / 3 cases, since during the injury the direction of the impact often coincides with the longitudinal axis of the toe. However, wedging of one fragment into another is rare. As a rule, there is a strong deformation of the cartilaginous tissue, accompanied by the appearance of several sub-articular cracks.

Lateral displacement of fragments with such fractures is extremely rare.

Fractures with longitudinal overlapping of fragments for each other are observed more often than injuries with a discrepancy, because in such cases, muscle contraction occurs and the surrounding tissues are pulled together, shifting the fragments. Longitudinal divergence in such injuries occurs with significant damage to the ligaments and muscles in the fracture area.

By the number of fragments, fractures of the toes are divided into:

  • slip-free;
  • one- or two-splinted;
  • multi-chipped.

Splinter-free fractures usually occur in falls. One- and two-splintered – when struck with a blunt object, and multi-splintered – when hit by an object with an uneven surface (for example, a stone).

Depending on the fault line, the fracture may be:

  • transverse;
  • longitudinal;
  • oblique;
  • helical;
  • T-shaped;
  • S-shaped, etc.

Depending on the location of the fault line, injuries can occur in the following areas of the toe:

  • main phalanx;
  • nail phalanx;
  • middle phalanx.

Sometimes two or more phalanges are damaged at the same time. A fracture of the big toe is isolated separately, since it consists not of three, but of two phalanges. Symptoms when it is damaged are more pronounced, since it carries the maximum load when walking.

Symptoms

Signs of toe fractures are divided into probable and reliable.

Possible symptoms of a broken toe include the following:

  • Pain in the injured finger;
  • redness and swelling of tissues in the area of ​​the fracture;
  • increase in tissue temperature in the area of ​​injury;
  • restriction or complete absence of movement of the injured finger;
  • Increased pain when tapping on the end of the finger;
  • Forced position of the injured finger.

Pain in such fractures can be different in intensity, but they are always tolerable and do not lead to loss of consciousness, as is the case with injuries of larger bones.

Particularly acute and strongly painful sensations are expressed precisely at the moment of bone fracture, since the periosteum is highly innervated. After a short time, the pain becomes dull and is caused by the development of bleeding, the appearance of edema and an inflammatory reaction.

In case of injury, substances such as serotonin, histamine and bradykinin are released into the bloodstream, which provoke the development of an inflammatory process in the area of ​​damage.As a result, swelling and redness appear in this place, and the temperature of the inflamed tissues rises. To reduce pain, the victim tries to find a position for the finger in which it will manifest itself to a lesser extent.

A symptom of increased pain when tapping on the top of the injured finger is a kind of test for determining a bruised or broken finger.

In case of violation of the integrity of one of the phalanges, pain appears at the site of its fracture, and with bruises of the finger, such sensations do not arise.It should be noted that such actions cannot be performed if there is a suspicion of displacement of fragments. In such cases, performing the test can provoke further misalignment and exacerbate the injury.

Significant symptoms of a toe fracture include the following:

  • detection of phalanx bone defect during palpation;
  • pathological mobility of the phalanx in an unusual place;
  • crepitus of fragments during palpation;
  • the injured toe becomes shorter than the same healthy toe on the other leg;
  • a broken finger deformity appears.

Such reliable signs of a fracture in almost 100% of cases indicate the presence of a fracture, but manipulations associated with palpation are always accompanied by severe pain and should be performed only by a specialist and as carefully as possible. Usually they are not performed, and the diagnosis is confirmed by X-ray.

First aid

An open wound should be treated with an antiseptic solution and applied with a sterile bandage.

As with other injuries accompanied by a violation of the integrity of the bone, first-aid care for fractures of the toes is aimed at eliminating pain, disinfecting wounds (if any), reducing hemorrhages and immobilizing the injured limb.It consists in carrying out the following activities:

  1. Eliminate the traumatic factor and seat the patient in a comfortable position, giving the leg an elevated position.
  2. Give an analgesic drug to take: Analgin, Nimesil, Ibufen, Ketanol, etc. Or, if possible, perform an intramuscular injection of an analgesic.
  3. In the presence of open wounds, treat them with an antiseptic solution and apply a bandage from a sterile bandage.
  4. Immobilization should be performed only if fragments are suspected to be displaced.In other cases, it is enough to give the leg an elevated position. If you need to immobilize your thumb, handy tools such as two pencils or plates covered with two layers of cloth can be used. They are held to the right and left of the toe and are bandaged to the shin. When immobilizing the other toes of the foot, there is no need to use a splint – the injured toe is bandaged to one or two healthy toes.
  5. Apply cold to the area of ​​injury to reduce pain and bleeding.Every 10 minutes the ice pack should be removed for 2-3 minutes to prevent frostbite.
  6. To transport a patient to a hospital, it is better to call an ambulance or to carry out this event on your own, but as sparingly as possible for the injured leg.

Diagnostics

Radiography is the gold standard for diagnosing fractures of the toes. The images are taken in one or two projections and allow you to create an accurate picture of the injury: displacement, fracture location, etc.p.

Treatment

The tactics of treating a fracture of a toe is determined by the clinical picture of the injury. For bone healing, the following methods can be used:

  • closed one-step reduction;
  • skeletal traction;
  • open reduction.

For open fractures, antibiotics are prescribed to prevent purulent complications and, if necessary, tetanus vaccination is performed.

Closed one-step reduction

This treatment is used to repair closed displaced fractures.

The area of ​​injury is anesthetized by injecting a local anesthetic into the surrounding soft tissue (after a preliminary test for an allergic reaction). As a rule, lidocaine or procaine is used for these purposes.

After the onset of the drug action, the injured finger is gradually extended. In parallel with this, the doctor performs the return of the fragments to the physiological position.

After matching the fragments, the mobility of all joints (metatarsophalangeal and interphalangeal) is checked.If not all joints remain mobile, then a second reduction is performed. If the movements in all joints persist, then immobilization is carried out using a plaster cast or other devices.

Skeletal traction

This method of treating fractures of the toes is indicated when closed reduction is not possible. For this, manipulations are performed to provide retraction and support of the distal fragment. They make it possible to prevent the divergence of fragments.

Skeletal traction is performed after local anesthesia. A special pin or nylon thread is drawn through the skin or nail phalanx, the ends of which are tied to give it the appearance of a ring. Subsequently, a wire hook is fixed to the gypsum, which will hold the ring in the position necessary for skeletal traction.

After performing these manipulations, the patient should wear a plaster cast for at least 2-3 weeks. At the same time, finger punctures are treated daily with antiseptic solutions (Cutasept, Betadine, alcoholic solution of iodine or brilliant green).After 2-3 weeks, the thread or pin is removed, and the finger is immobilized again for the same period for complete bone healing.

Open reduction

Indications for performing a surgical operation – intraosseous osteosynthesis – may be the following cases:

  • open fracture;
  • multi-splinter fracture;
  • complications arising from other methods of treatment.

Such interventions allow restoring the integrity of the bone with visual control and provide high reliability of fixation of fragments using metal devices.

Pins, screws, plates and wires are used for intraosseous fixation. The selection of this or that device is determined by the clinical picture of the fracture. After the completion of the operation, immobilization is performed using a splint or plaster cast for 4-8 weeks.

In more rare cases, osteosynthesis is performed using a system of metal rods fixed with circles or half-arcs – the Ilizarov apparatus. This is due to the cumbersomeness of such structures or the lack of apparatus of the required dimensions.

Possible complications

In the absence of treatment, non-compliance with the doctor’s recommendations or inadequate choice of the method of treatment, the following complications may develop:

  • false joint;
  • giant callus;
  • Incorrect fusion of fragments;
  • 90,011 ankylosis;

  • osteomyelitis;
  • gangrene.

Is plaster always applied

For immobilization in case of fractures of the toes, a plaster cast or other polymeric materials can be used that can provide reliable immobilization.For the patient, the most convenient dressings are made of polymers, since

they are lighter and are not exposed to water (when wearing them there are no restrictions on hygiene measures). In addition, polymeric materials, unlike gypsum, always remain warm and do not “cool” the foot. Such hypothermia when wearing a plaster cast can lead to a violation of the strength of the callus.

The only drawback of polymers used for immobilization is their high cost.

An immobilizing bandage for fractures of toes is applied not only to the injured toe, but also covers the entire foot and the lower third of the lower leg. Only with this method of applying a “boot” bandage is it possible to achieve complete immobilization, which is necessary for a successful bone fusion.

In some cases, immobilization is not performed. These exceptions include:

  • cracks in the phalanges – they are repaired on their own;
  • first days after surgery on the leg with concomitant fracture of the fingers – a plaster cast is applied after the beginning of the healing of the postoperative wound;
  • Use of the Ilizarov apparatus – fixation of fragments is provided by the device itself.

How long the plaster lasts

The duration of immobilization of a limb in case of toe fractures depends on many factors – the complexity of the injury, age, concomitant pathologies that impede bone fusion. Dates of wearing plaster can be as follows:

  • for closed fractures without displacement – 2-3 weeks, working capacity is restored in 3-4 weeks;
  • for fractures with displacement or the presence of multiple fragments – 3-4 weeks, working capacity is restored after 6-8 weeks;
  • for open fractures or after osteosynthesis – 5-6 weeks, work capacity is restored after 9-10 weeks.

Rehabilitation

Physiotherapy exercises helps to restore the functions of the damaged finger.

The duration of rehabilitation after fractures of the toes depends on the same factors as the duration of immobilization. As a rule, the recovery period is about 3-4 weeks, but with multi-splinter injuries it is extended by 2 weeks. The development of complications leads to a significant slowdown in rehabilitation – it is almost doubled.

To restore the functions of the damaged finger, the following are assigned:

  • physiotherapy exercises;
  • massage courses;
  • physiotherapy procedures (UHF, hot salt or ozokerite applications, mechanotherapy, salt and soda baths).

A fractured toe should always be a reason to see a doctor.

Incorrect treatment of such injuries can lead to the development of serious complications that will cause the victim a lot of suffering and worsen his quality of life.

To eliminate such fractures, various techniques can be used, the choice of which depends on the nature of the fracture. Subject to all the recommendations of the doctor and the correct choice of treatment, such injuries respond well to therapy.

Which doctor to contact

If you suspect a toe fracture, you should consult an orthopedist. After examining the victim, the doctor will definitely prescribe an X-ray and, based on its results, draw up the most effective treatment plan.

Source: https://myfamilydoctor.ru/priznaki-pereloma-palca-na-noge-lechenie/

Fracture of the little toe: symptoms, first aid, treatment

The bones of the little finger are thin compared to other bones in the skeleton.Therefore, a fracture of the little toe is not uncommon. The probability of injuring the little toe is 5% of the sum of all fractures of the lower extremities. If we take into account the cases where the fracture has not been treated, the percentage will increase to 15%.

Reasons

A common cause of a broken toe is trauma to the toe. Since the bone of the little finger is small and fragile, a weak impact is enough to cause a fracture.

The fall of a heavy object on the little finger or the impact of a finger on a hard corner is enough to get the little toe fractured.

Another common cause leading to a fracture of the phalanx of the little finger is a pathological factor. This happens when there is insufficient bone strength due to a disease, for example:

  • tuberculosis;
  • osteoporosis;
  • the presence of tumors in the body;
  • osteomyelitis, etc.

A fracture of the little toe is often caused by players in team sports such as football, field hockey, rugby. Despite the fact that the bone of the little finger is small and fragile, the fusion process takes a long period of time and requires maximum effort and patience.

Symptoms

Symptoms of a fracture of the little finger on the leg are pronounced, which makes it possible for the traumatologist to make the correct diagnosis and begin treatment. When the little toe is broken, the person experiences the following symptoms:

  1. Acute local pain (directly in the little finger), or pain that covers the entire foot.
  2. The appearance of edema. Immediately after the fracture, the foot becomes larger in size. The inflammatory process starts and the permeability of the walls of blood vessels increases.The process of edema performs a protective function; in case of a comminuted fracture, the swollen tissues prevent the displacement of bone fragments, which helps to avoid surgical intervention.
  3. Bruising (bruising). The phalanges of the finger are equipped with their own network of blood vessels and are well supplied with blood. When a bone fracture occurs, the walls of the blood vessels are damaged and some of the blood seeps into the soft tissue, which gives the injured toe a blue color.
  4. When the little finger is fractured with an offset, a deformity of the finger is formed, which is noticeable even to an inexperienced person.
  5. An open fracture is accompanied by damage to the skin and the formation of a wound through which fragments of bone tissue are visible.

First aid for fracture of the little toe

In case of an open fracture, the first step is to disinfect the wound. Otherwise, the sequence of actions for a closed and open fracture is the same.

  1. If a toe injury occurred while the foot was in the shoe, free the foot from the shoe and toe.The leg should be in a position that excludes even a slight impact on the toe. This will protect the victim from severe pain.
  2. It is imperative to take an analgesic that is at hand. The pain of the fracture builds up gradually, in order to prevent the feeling of unbearable pain, it is important to take the pain reliever right away. The drug takes time to take effect. The sooner the medicine enters the body, the faster the pain relief process will begin.
  3. If a displaced toe fracture occurs, an immobilization process must be performed.This process involves fixing the injured toe by wrapping it around the adjacent, healthy toe. This procedure helps to exclude further displacement of the bone fragments. After the immobilization procedure, you can start transporting the patient to a medical facility. With a fracture without displacement, immobilization is not required.
  4. Ice or cold object is applied to a broken finger. This will reduce pain and prevent the formation of swelling and inflammation.
  5. When applying ice to an injured finger, avoid direct contact of the ice with the skin. You need to use a compress with ice wrapped in a towel or a special heating pad.

Diagnostics

It is possible to accurately determine the presence of a fracture of the little finger bone only with a doctor’s examination and examination of the fracture using an X-ray. An X-ray makes it possible to confirm or deny the diagnosis, to identify the type of fracture. There are several types of fracture:

  1. Non-displaced bone fracture.This is a type of fracture in which two pieces of bone are aligned with each other.
  2. Fracture of the little finger with displacement. With this type of fracture, parts of the bone are displaced, this type of fracture is rare, the recovery process is more difficult.
  3. Comminuted fracture. A complex type of fracture, in which several fragments are formed at once. With this type of fracture, it is often necessary to resort to surgical intervention in order to collect the fragments of the bone together and fix it.

Treatment

There are two treatment options for the fracture:

  • conservative method;
  • surgical method.

Conservative treatment involves the application of a plaster cast over the injury site. In case of a fracture of the little finger with a displacement, a reduction procedure is preliminarily performed. The bone fragments are returned to the anatomically correct position and fixed with a plaster cast.

The process of reduction is carried out both without surgical intervention, and with its help. The doctor acts based on the type of fracture. Surgical reduction is used for comminuted fractures.

Fragments of bone are fixed using a plate, this method is called osteosynthesis.To avoid possible complications, the victim is prescribed pain relievers and anti-inflammatory drugs.

Is it necessary to wear a plaster cast when the little toe is broken?

A fracture of the little toe does not always require a plaster cast, it is determined based on which part of the toe is injured. The decision to apply a plaster cast is made by the doctor.

  • If the nail phalanx is broken, then the case can be done with a perforation procedure, the doctor will make an incision to rid the finger of blood accumulations.
  • If the main or middle phalanx of the toe is broken, then the entire foot is fixed with a plaster cast, and it is removed only after the final fusion of the bone.
  • It is also possible to install a pin or staples, depending on the complexity of the fracture.

The plaster cast can be replaced with a modern and comfortable analogue – scotch tape. It is a synthetic bandage impregnated with a special type of resin, which solidifies when wet. The doctor may suggest using a special brace for the little toe in case of a fracture.

How long does it take for the fracture of the little toe to heal?

The healing time of the bones of the little finger is individual and depends on the characteristics of the organism, the age of the patient, the nature of the fracture, etc. On average, it will take 1-2 months for the fracture to heal without displacement.

Rehabilitation

The main condition for quick recovery is the state of rest of the injured limb. The leg should not be stressed.

After the doctor concludes that the little finger bone has grown together, the plaster cast will be removed and the rehabilitation period will begin.

This period is for the development of the damaged toe in order to return it to its previous functionality and gradually prepare the finger for maximum stress.

The rehabilitation period consists of exercise therapy (physiotherapy exercises), a course of massage and physiotherapy procedures, enrichment of the diet with foods containing a lot of calcium, which helps to strengthen bone tissue.

Complications

Basically, a fracture of the little toe on the leg is not accompanied by pronounced clinical symptoms.Therefore, there is a late diagnosis of the injury. If the pain is tolerable, some patients prefer to endure and do not seek advice from a traumatologist. In others, the fracture of the little finger goes completely unnoticed.

Inattentive treatment of the body and health can lead to serious consequences, which are extremely difficult to reverse.

Large callus

The formation of callus occurs when any fracture heals. This connective tissue is formed to connect the fragments of the bone, ensuring its continuity and restoration of previous functions.The size of the callus depends on the distance between the bone fragments.

The more accurately the parts of the bone are matched, the thinner the callus will be, and the healing process will be faster. If a person does not seek qualified help and bone fragments are not repositioned, this contributes to the excessive proliferation of connective tissue between all fragments.

The result is slow healing of the injury, regular pain and inflammation.

False joint formation

Ignoring a displaced fracture leads to such a complication. Due to the distant bone fragments, the fusion process does not start.

The process of closing the bone canals begins, rounding off the fragments and the formation of two phalanxes in place of one phalanx. However, such a joint is not considered complete due to the lack of cartilage between the bones.

As a result, the constant rubbing of the bones against each other causes severe pain and provokes an inflammatory process.Such a finger cannot fully fulfill its function.

Ankylosis

Ankylosis is the closure of the joint space by the fusion of two phalanges. This phenomenon is common when the little toe is fractured. It is associated with the anatomical structure of the bone of this finger.

The phalanges of the little finger are short, and the fracture affects the bone below the joint surface (subchondral region). A violent inflammatory process begins, which contributes to the fusion of the joint space.

First, callus is formed, which eventually turns into bone tissue.

Osteomyelitis

Osteomyelitis is the most severe consequence of bone fracture, which is difficult to treat. This is a purulent-necrotic process that takes place in the bone marrow and bones, affecting the surrounding soft tissues.

This process is a consequence of an open fracture, when bacteria and harmful microorganisms from the external environment penetrate into the inner layer of the bone. Therefore, it is so important to treat an open fracture with a disinfectant.

Fracture of the little toe is a dangerous and intractable injury.If you do not pay enough attention, in the future there is a possibility of losing the functionality of the finger. If you find the slightest signs of a fracture of the little toe, even in the absence of pronounced symptoms, you need to contact a competent doctor who will provide the necessary medical assistance.

Source: https://ChtoiKak.ru/perelom-mizinca-na-noge.html

Rehabilitation after a broken leg | “Laboratory of Movement” SPb

Despite the fact that many injuries do not require surgical correction, a sufficiently long treatment process can lead to negative health consequences.To speed up the recovery time from a broken leg, specialists at the Movement Laboratory health center in St. Petersburg are using an innovative approach to rehabilitation. In addition to the above-mentioned conservative methods, innovative technologies are used here to improve the final result:

CPM-mechanotherapy

CPM (Continues Passive Motion) means “constant passive motion”. Rehabilitation simulators are used for fractures of the ankle, calcaneus and talus.They help to mobilize joints and correct anatomical movement, and prevent the formation of contractures.

Kinesiotherapy PNF

Proprioceptive neuromuscular fatigue (PNF) is a type of motion therapy aimed at restoring functional connections between muscles and the central nervous system. Manual stimulation (stretching and squeezing of prioreceptors) eliminates muscle spasms and pain syndrome, improves the condition of the motor centers, restores lost movement patterns.

Instrumental mobilization of soft tissues IASTM

IASTM-therapy – kinesio correction using special instruments (blades). Stimulation of soft tissue injuries accompanying a bone fracture reduces pain syndrome, activates the growth of fibroblasts, prevents the development of cicatricial changes and facilitates the healing process.

NEURAC Technique

NEURAC Kinesiotherapy is actively used to restore leg mobility after plaster cast removal. The technique, aimed at working out weakened deep muscles and neuromuscular activation, includes sets of exercises on a specialized harness.Classes are held in the absence of axial load on the spine and joints. Controlled range of motion and vibration helps to eliminate pain and normalize the work of the musculoskeletal system.

Manual therapy (Mulligan and Kaltenborn-Event concept)

Mobilization with movement is an effective rehabilitation method recommended for leg fractures after plaster cast removal. Simultaneous active physiological movements of the patient and auxiliary support of the chiropractor in the “correct” treatment plane contribute to the acceleration of painless work of the joints.

Medical fitness

To adapt the body after trauma and improve overall health, the “Laboratory of Movement” RC uses the practices of yoga therapy and Pilates. With their help, post-traumatic stress is reduced, an increase in bone density along the fracture line is accelerated, and the consequences of prolonged forced hypokinesia are eliminated.

A crooked toe is not only an aesthetic problem – Baltic Medical Center

Outward curvature of the big toe (in Latin – hallux valgus) or, in other words, “popping out bumps on the toes”, deformed foot bones are the most common foot deformity among women.

Let’s talk about the causes of this deformity and its treatment with Matas Nenartenas, an orthopedic traumatologist at the Baltic Medical Center.

What are the causes of the curvature of the big toe?

Many people believe that toe curvature is due to wearing high-heeled shoes or flat feet, but this is only partly true. In fact, this deformation is hereditary. About 80% of patients notice that such a deformity was in the mother, grandmother or other close relatives.

True, such external factors as shoes with a narrowed toe, shoes with high heels can undoubtedly deform healthy feet over time.

This pathology of the foot is also associated with weakness of muscles and ligaments, impaired function. Frequent pregnancy also sometimes contributes to the occurrence of this problem. If a woman puts on a lot of weight, then due to the increased load, the ligaments are weakened, and as a result, deformity of the foot may begin.

In women, this problem occurs much more often than in men.The spread of this deformity among women is almost 10 times more.

How to help a patient in case of a deformity of the big toe?

Unfortunately, if the deformity is painful and progressing, then the treatment can only be surgical. Conservative measures such as the gaps between the fingers are ineffective, and in some cases can even be harmful. When using such means, the small fingers are pushed to the side, as a result of which their deformations can occur.

Are curvatures of the finger just an aesthetic problem or does it affect health as well?

This is not only an aesthetic problem. Due to the fact that the articular surface of the fingers wears out faster and pain occurs, this is primarily an orthopedic problem. We lean on the foot, which makes up a small area that carries the body’s weight, so at the moment of repulsion, the load force is very large. Often people do not even imagine the load that falls on their feet.

Patients come to us most often because of pain, and not for aesthetic reasons.

When should I see a doctor?

The first pain is a signal of the need to consult an orthopedic doctor. If the bones are not treated, the pain will intensify, and the other toes and the foot will begin to deform.

The sooner a person consults an orthopedic surgeon after the first signs of foot deformity and pain appear, the easier and faster the treatment process will be.

How to help a patient in case of a deformity of the big toe?

The most important thing is to look after your feet, keep them healthy and not overdo it with wearing uncomfortable shoes. After all, our body rests precisely on the feet, and they support all its weight. Therefore, I recommend very carefully choose comfortable shoes that are suitable for their physiology, with a heel height of 2-3 centimeters and a fairly wide front part. It is not recommended to constantly and often wear high-heeled shoes.

When do you make a decision about the need for an operation?

When consulting patients, I try to adhere to the following principle: as long as there is no pain and discomfort, surgery is not required. Any surgical intervention is risky to a certain extent, so it is necessary to weigh the pros and cons. If the quality of daily life is deteriorating due to foot pain, then surgery may be considered. The pain is felt not only due to the friction of the bone against uncomfortable shoes and calluses, but it occurs in the foot itself after walking.Exhausting pain is a signal of the need for treatment and it is better not to postpone it on the back burner. The smaller the deformation, the easier the operation and the better the results.

How is the operation performed?

The surgery technique is selected by the surgeon depending on the patient’s age, degree of deformity and bone structure. The operation consists not only in the restoration of the bone, but also in the correction of the surrounding tissues. During the operation, intravenous anesthesia is used.The operation takes about an hour.

What is the postoperative period? When can a person return to work and daily activities?

Modern surgery has taken a big step forward. In the postoperative period, minor pain may occur for 1 to 2 days, but it can be relieved with medication. If the deformity is small, then the postoperative period will take about a month. Those who work in the office will be able to return to work in about 5 weeks.

In the postoperative period, you can only lean on the heel. Currently, there are special postoperative shoes in which walking is quite comfortable and safe. It is very important to follow the instructions of the doctor, because if you place your foot incorrectly, and all the work will go to waste.

Physical activity on the foot is restored gradually with physiotherapy and certain physical exercises. Therefore, the postoperative period is highly dependent on the consciousness and mood of the patient.

If the problem is the same on both legs, is it possible to operate on both legs at once?

We recommend to operate with one foot. It is necessary that the operated foot is completely healed and its functions restored.

What are the results of the operation? Can the deformation recur?

Most often, surgical treatment is successful. With proper operation, the probability of deformity resumption is about 5%.

There is a high probability in the case of such an operation for children, because their skeleton has not yet been fully formed.Therefore, it is recommended to operate on adults.

Repeated trauma can complicate the results of the operation.

90,000 Metatarsal fractures – GKB named after A.K. Eramishantseva

Metatarsal fractures are the leading fractures of the foot, which has a complex anatomical structure. For the successful treatment of such a fracture, the traumatologist must carefully analyze each particular case of such a condition, because the tactics of therapy differ depending on the location and type of damage.

Symptoms of metatarsal fractures:

  • gradually developing soreness; increasing intensity with load on the foot;
  • hematomas;
  • swelling;
  • lameness;
  • inability to lean on the leg and move independently;
  • deformity of the toes.

Among the causes of metatarsal fractures:

  • long-term high intensity loads;
  • Impact of heavy objects;
  • 90,011 accidents;

  • degenerative-dystrophic changes in bone tissue;
  • jumping from a height.

Traumatologists divide this pathology into:

  • traumatic fractures arising from the deforming effect on the parts of the foot;
  • Stress fractures that develop as a result of heavy loads against the background of perfectly healthy bones of the metatarsus.

To make an accurate diagnosis of a metatarsal fracture, the traumatologists of our department carefully collect an anamnesis of the trauma, finding out from the patient its mechanism, possible force, and the direction of its application.Often, the development of stress fractures of this part of the skeleton occurs at a high intensity or duration of cyclic movements, including running, dancing, etc.

To confirm the diagnosis, an X-ray is taken after examining the confirmed limb. Such a study on the best modern devices can be repeated by the doctors of our Center for Traumatology and Orthopedics of the City Clinical Hospital. them. A.K. Eramishantseva. The purpose of repeat radiographs is to monitor treatment outcomes. To exclude stress fractures of the metatarsal bones of the foot, such modern research methods as MRI and CT can be used.

The treatment of metatarsal fractures will depend on the location, the type of injury, and the presence or absence of displacement. In complicated cases, the fragments are repositioned, followed by osteosynthesis with special plates and wires. In uncomplicated cases, such fractures are treated by immobilizing the limb.

The widespread occurrence of such a pathology requires the attention of specialists. Be sure to contact a traumatologist, even if you have received first aid and it seems that “the leg is easier”.Absent or inappropriate treatment can result in serious complications.

Rehabilitation of the foot after operations and fractures in Moscow

Efficiency

For rehabilitation after foot surgery or for fractures, physiotherapy exercises are used, the characteristics of the exercise complex of which are influenced by the nature of the damage. At a certain stage, appropriate exercises are selected and only a professional doctor should do this.

At stage 1, it is possible to perform passive movements. Later, it is already possible to dosed loading the limb. At stage 2, a set of exercises is prescribed that help develop the ankle joint, foot bones , for which special devices are used, including simulators. It is recommended to visit the pool, in which various exercise therapy procedures are also carried out.

Physiotherapy is used when recovering from foot injuries or operations performed on it.At stage 1, it is permissible to use electrophoresis, magnetotherapy, and some other physiotherapeutic methods. At stage 2, in order to improve tissue trophism, accelerate fracture consolidation, magnetic laser therapy is used. Infrared procedures are performed. Massage also helps speed up the recovery process. In some cases, certain types of physiotherapy are not allowed. So, in metal osteosynthesis, ultrasound is not used, which can lead to an undesirable effect.At the 3rd stage, thermal procedures are performed, darsonvalization, electrotherapy, bathing are recommended, therapeutic massage is prescribed.

At the Medical Center +31, rehabilitation is carried out after the elimination of various injuries of the ankle, including if foot surgery was performed . The knowledge and experience of qualified specialists, modern techniques and equipment allow you to restore the functionality of the ankle in the shortest possible time. The complex of measures carried out by our doctors, which is prescribed individually in each specific case, makes it possible to return to a full life soon.

Fractures of the fifth metatarsal bone

Today I would like to tell you about the unique experience of treating one of the most unpleasant problems faced by football players and doctors – fractures of the fifth metatarsal bone.

Their treatment is very complex and these injuries often recur (as, for example, in Neymar and Manuel Neuer).

I wrote with colleagues from FC Zenit Vladimir Khaitin and FC Lokomotiv Gleb Chernov a small material on this topic with relevant links that must be taken into account by doctors and coaches in physical training and rehabilitation, so as not to further multiply myths and legends deep antiquity))

“Our experience in treating fifth metatarsal fractures in professional football players using platelet-rich plasma”

Injuries to the metatarsal bones in football are relatively rare and in most cases are localized in the fifth metatarsal bone.

The main method for diagnosing fractures of this localization can be called X-ray, which in most cases allows you to verify the diagnosis.

Treatment tactics depend on the location of the fracture according to the classification of Lawrence and Botte’s, according to which there are three zones of their localization.

Fractures located in zones 2-3 are at high risk of delayed consolidation and non-union, and therefore in athletes they are most often treated with osteosynthesis using intramedular screws.

The average recovery time with this type of treatment is at least 8 weeks.

This report describes five cases of fractures of the fifth metatarsal bone, located in zones 2-3 in professional football players, who were treated with an immobilization boot, cryotherapy, dietary supplements of calcium and vitamin D and local injections of platelet-rich plasma, which contains multiple factors growth.

The period of return to regular training activity was 43-50 days, and no recurrence of damage was found within 6 months of follow-up.

Introduction

Treatment of fractures of the fifth metatarsal bone among athletes is an urgent problem due to the long duration of treatment (8 weeks or more) and a large number of relapses [1].

In football, they account for 0.5% of all injuries sustained by elite European footballers with an average treatment period of about 80 days, regardless of the type of treatment chosen [2]

This type of fracture is one of the few diagnostics based on radiography, which in most cases allows to verify the diagnosis.

This type of fracture is one of the few diagnoses that are based on X-ray, which in most cases allows the diagnosis to be verified.

In the population of athletes, the tactics of treating such injuries depends on their localization according to the classification of Lawrence and Botte’s, in which there are three zones [3].

Fractures of the first zone are most often treated conservatively with good functional results in any of the population categories.

Fractures of the second and third zones with conservative treatment have a tendency of delayed consolidation and non-union, therefore the most common method of their treatment, especially in the population of athletes, is osteosynthesis using intramedullary screws [4].

Development of new methods of conservative treatment of such fractures with minimal treatment time and the number of relapses is an urgent task for modern professional football.

One of such techniques can be the use of PPP, which contains numerous growth factors.

BTP is actively used in the treatment of acute and chronic injuries of the musculoskeletal system, in particular, muscle injuries, tendinopathies and arthrosis with positive results [5,6].

Experiments on animals have shown a beneficial effect of PTP on the healing of both traumatic and osteorotic fractures [7,8].

However, we could not find data on the use of PPP in the treatment of metatarsal fractures.

Description of cases

The results of treatment of fractures of the fifth metatarsal bone in five young football players are presented.

The players were 19-21 years old, 178 cm tall, and weighed 71-75 kg.

All injuries occurred between November 2016 and June 2018 during matches during the competition season. In all cases, the game was played on an artificial turf.

There was no discomfort or pain in the area of ​​the fifth metatarsal before the moment of injury.

The mechanism of injury in three cases was contact, in two non-contact – during running with acceleration, a sharp local soreness appeared in the projection of the fifth metatarsal bone.

All footballers immediately stopped their sports activities and were immobilized with an orthosis.

In all cases, the performed radiography confirmed the diagnosis (Figure 1).

In the first three days, the initial therapy was carried out according to the POLICE protocol, which included the use of cyclic compression therapy (7-8 times a day for 20 minutes), wearing a compression hosiery, and a mediROM Walker immobilization orthosis.

Nonsteroidal anti-inflammatory drugs were not used in any case.

From the first day of treatment, calcium began to be used at a dose of 1000 mg per day and vitamin D at a dose of 5000 IU for 60 days.

The first injection of platelet-rich plasma (4-5 ml) was performed 3 days after the injury.

Three such injections were performed with an interval of 7-10 days.

From the 3rd day after the first injection of PPP, low-intensity training on a bicycle ergometer began at 30-40

From the 7th day of treatment, rehabilitation training began, aimed at improving blood circulation with the use of exercises without axial load on the foot.

In all cases, 5-7 days after the second injection of PTP, the pain syndrome during normal walking stopped, but the use of the orthosis continued for 30 days from the moment of injury.

Three days after the disappearance of the pain syndrome, low-intensity running work (10-15 minutes) began with subsequent progression.

From the 30th day, all the players began to work individually with the ball in boots.

The time to return to regular training activity varied in the range of 43-50 days.

Control X-ray was taken 3-5 days before the start of RTD.

There were no allergic reactions or other side reactions during treatment.

Discussion

Fractures of 2-3 zones of the fifth metatarsal bone are at high risk for delayed consolidation and non-union.

The data available to date on conservative treatment report a long return to RTD and a large number of relapses.

Thus, Japjec et al. the average duration of treatment for most fractures of 2-3 zones after osteosynthesis was 8 weeks, and with conservative treatment, even after 6 months, more than half of the patients had no signs of consolidation and remained painful [9].

In this regard, in most cases, in the group of professional athletes, surgical treatment is currently considered the method of choice in the treatment of such fractures.

Hunt KJ, et al.reported on 21 athletes operated on with an average recovery time of 12.3 weeks using osteosynthesis using intramedular screws and only one re-fracture.

O’Malley et al. Reviewed the results of surgical treatment of 10 NBA basketball players with a median recovery time of 9.8 weeks. At the same time, repeated fractures occurred in three cases [10].

Thus, the currently available data show that even the surgical treatment of fractures of 2-3 zones of the fifth metatarsal bone is characterized by a long rehabilitation period and frequent recurrent fractures.

In this regard, the data obtained by us on the conservative treatment of such injuries using local injections of PPP may be of interest for further research.

References

1. Chi Nok Cheung1 and Tun Hing Lui1, *. Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications Arch Trauma Res. 2016 Dec; 5 (4): e33298. Published online 2016 Jun 13. doi: 10.5812 / atr.33298

2.Ekstrand J1, van Dijk CN. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. Br J Sports Med. 2013 Aug; 47 (12): 754-8. doi: 10.1136 / bjsports-2012-092096. Epub 2013 Apr 9.

3. Lawrence SJ1, Botte MJ. Jones’ fractures and related fractures of the proximal fifth metatarsal. Foot Ankle. 1993 Jul-Aug; 14 (6): 358-65.

4. Hunt KJ1, Anderson RB. Treatment of Jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting.Am J Sports Med. 2011 Sep; 39 (9): 1948-54. doi: 10.1177 / 0363546511408868. Epub 2011 Jun 1.

5. Grambart ST1. Sports medicine and platelet-rich plasma: nonsurgical therapy. Clin Podiatr Med Surg. 2015 Jan; 32 (1): 99-107. doi: 10.1016 / j.cpm.2014.09.006.

6. Laudy AB1, Bakker EW2, Rekers M3, Moen Mh5. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015 May; 49 (10): 657-72. doi: 10.1136 / bjsports-2014-094036. Epub 2014 Nov 21.

7. Simman R1, Hoffmann A, Bohinc RJ, Peterson WC, Russ AJ. Role of platelet-rich plasma in acceleration of bone fracture healing. Ann Plast Surg. 2008 Sep; 61 (3): 337-44. doi: 10.1097 / SAP.0b013e318157a185.

8. Chen L1, Yang X, Huang G, Song D, Ye XS, Xu H, Li W. Platelet-rich plasma promotes healing of osteoporotic fractures. Orthopedics. 2013 Jun; 36 (6): e687-94. doi: 10.3928 / 01477447-20130523-10.

9.Japjec M1, Starešinić M2, Starjački M2, Žgaljardić I3, Štivičić J2, Šebečić B2. Treatment of proximal fifth metatarsal bone fractures in athletes. Injury. 2015 Nov; 46 Suppl 6: S134-6. doi: 10.1016 / j.injury.2015.10.052. Epub 2015 Nov 10.

10. O’Malley M1, DeSandis B2, Allen A1, Levitsky M1, O’Malley Q1, Williams R1. Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA. Foot Ankle Int. 2016 May; 37 (5): 488-500. doi: 10.1177 / 1071100715625290. Epub 2016 Jan 18.

Longitudinal and transverse flat feet

FLAT FEET is a deformity of the foot, in which a lowering (flattening) of its arch occurs.

Normally, the foot has two arches – longitudinal (along the inner edge of the foot) and transverse (between the bases of the toes). Both arches of the foot are designed to maintain the balance of the body and prevent the body from shaking when walking.

If the load on the foot is balanced by strong ligaments and muscles, then the foot functions normally.In most cases, flat feet occurs due to weakness and overwork of the muscles of the lower leg and foot. It can be caused by standing or walking for a long time, obesity, tight and inappropriate shoes.

Also, flat feet contributes to the formation of improper posture, however, the opposite option is also possible, when a violation of posture leads to flat feet. As a result, the legs quickly get tired, the knees suffer first of all, due to the fact that they are experiencing a lot of stress.In addition, the load on the spine increases.

Classification of flat feet

  • By localization
    • Cross
      Signs: With transverse flat feet, the forefoot expands. The support is made on all heads of the metatarsal bones, and not on the first and fifth, as is normal. The load on the previously unloaded 2-4 heads of the metatarsal bones sharply increases, and the load on the head of the first metatarsal bone decreases.Also, the direction of action of the muscles that are attached to the big (first) toe of the foot changes. This causes the big toe to be deflected inward. The head of the first metatarsal bone protrudes outward, and the thumb rests on the second at different angles. This deformity of the big toe is called Hallux valgus.
    • Longitudinal
      With longitudinal flat feet, the bones of the foot are displaced in such a way that the forefoot is deflected outward.The tendons of the peroneal muscles are stretched, the anterior tibial muscle, on the contrary, is stretched. The appearance of the foot changes. The foot becomes elongated. Its middle part is expanded. The longitudinal arch is lowered, the entire foot is turned inward. On the inner edge of the foot, the outlines of the scaphoid are visible through the skin. This condition of the foot is manifested when the gait becomes clumsy, with the toes well apart. And also: there is rapid fatigue of the legs, aching pains in the feet and legs when walking and standing, in the evening, swelling of the foot may appear.The inner side of the sole wears out quickly. The foot becomes wider. With a pronounced deformity, constant pain appears in the feet, legs, knee joints. Lower back pain and excruciating headaches appear. Working capacity decreases, short walking is difficult. Callosities of the skin of the sole appear under the heads of the metatarsal bones. Tension of the extensor tendons of the fingers, deviation outward of the thumb.
    • Longitudinal-transverse

    • Flat-valgus feet

    • Valgus feet

    • Functional failure of the feet
  • Originally
    • Congenital flat feet: About 3% of flat feet are congenital.Establishing earlier than 5-6 years is not easy;
    • Traumatic: a consequence of the fracture of the ankles, calcaneus, tarsal bones;
    • Paralytic: a consequence of paralysis of the plantar muscles of the foot and muscles starting on the lower leg;
    • Rachitic: Caused by the body putting stress on the weak bones of the foot;
    • Static: The most common flatfoot. It occurs with weakness of the muscles of the lower leg and foot, ligamentous apparatus and bones;
    • Acquired: The result of wearing uncomfortable shoes that compress and constrict the foot, high-heeled shoes.

Stages of flat feet

  • First (initial) stage
    In the evening, the legs get tired even after the usual load. When you press on the middle of the sole, pain occurs. By the morning, as a rule, the swelling disappears.
  • Second stage
    Flatfoot reminds of itself all day long with unbearable pain in the feet and legs. Long walks are excluded. The gait becomes heavy, posture is disturbed.
  • Third
    Walking is extremely difficult, the feet are severely deformed and resemble the usual outlines only by their location.Arthrosis, arthropathy, changes in the spine and other complications appear. Patients are disabled.

Diagnostics

  • At the first stage, an examination is carried out by a specialist, in this case a traumatologist-orthopedist.
  • The second stage is hardware diagnostics. There are various methods for diagnosing flat feet. X-ray diagnostics is a widespread method.