II. Epidemiology
- Proximal phalanx most commonly injured (esp. 5th)
III. Mechanism
- Heavy object dropped on toe (crush injury)
- Stubbed toe
IV. Signs
- Focal pain, swelling and Ecchymosis
- Painful ambulation
V. Imaging
- Three view XRay (AP, Lateral, Oblique) of the affected toe and foot
VI. Management: Indications for orthopedic referral
-
General indications
- Perfusion defect (emergency)
- Open Toe Fracture (suspected or actual)
- Skin necrosis overlying Fracture site
- Great Toe Fracture indications (includes general above)
- Lesser Toe Fracture indications (includes general)
- Fracture dislocations
- Displaced intra-articular Fractures
- Children with Salter-Harris Fractures III to V
- Angulation >20 degrees in dorsoplantar plane or rotation, or >10 degrees in mediolateral plane
VII. Management: Great Toe Fractures
- Reduce displaced Fracture as with Lesser Toe Fractures (see below)
- Great toe is key to weight bearing, walking and balance
- Alignment is more critical for great toe than for the lesser toes
- Initial: Immobilization
- Short Leg Walking Cast with toe plate or short leg walking boot for 2-3 weeks
- Continue immobilization if persistent symptoms
- Next: Progress if minimal symptoms
- Buddy taping and rigid-soled shoe for 3-4 weeks
- Start range of motion Exercises at 4 weeks
- Referral Indications
- Follow great toe XRays
- Post-reduction films
- Repeat in 7-10 days (5 days for a child)
- Repeat weekly if unstable or intra-articular Fracture
- Healing course
- Expect 4-6 weeks total
- Athletes may require >8 weeks to return fully to activity
VIII. Management: Non-displaced Lesser Toe Fractures
- Acute management for first 72 hours
- Rest
- Ice Therapy for 20 minutes of each hour (avoid Frostbite)
- Elevation
-
Splinting 3-6 weeks until non-tender
- Hard soled shoe AND
- Buddy taping Fractured toe to adjacent toe
- Use cotton padding between toes and tape together
- Re-tape every 2-3 days
- Alternatives
- Consider Walking boot or Short Leg Walking Cast if pain not controlled with hard shoe and taping
- Referral Indications
- Similar to Great Toe referral indications (see above)
- Follow-up care
IX. Management: Displaced lesser (2-5) Toe Fractures
- Digital Block to anesthetize affected toe
- Reduce Fracture with longitudinal traction
- Continue manipulation if rotational deformity
- Toe nail should lie in same plan as adjacent toes
- Splint with buddy taping after reduction (see above)
- Refer if reduction not maintained in splint (or other referral indications as above)
X. Management: Subungual Hematoma
- Decompress with needle or cautery
- Avoid nail removal if possible
- Acts as distal phalanx splint
- Some recommend nail removal for Hematoma >50%
- Explore wound and suture Nail Bed Laceration
XI. Differential Diagnosis
- Sesamoid Fracture (great toe)
XII. Complications
- Malunion resulting in persistent pain
- Degenerative Joint Disease (intraarticular Fracture)
- Osteomyelitis (open Fractures)
XIII. References
- Marx (2002) Rosen's Emergency Medicine, p. 731
- Silver (2024) Am Fam Physician 109(2): 119-29 [PubMed]
- Simon (2001) Emergency Orthopedics, McGraw, p. 554-7
- Bica (2016) Am Fam Physician 93(3): 183-91 [PubMed]
- Hatch (2003) Am Fam Physician 68:2413-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 21351003, 263254001, 157253009 |
Dutch | gebroken teen, falanx; fractuur teen, fractuur; falanx teen, fractuur; teen |
French | Orteil fracturé |
German | gebrochene Zehe |
Italian | Dito del piede fratturato |
Portuguese | Dedo do pé fracturado |
Spanish | Dedo de pie fracturado, fractura de la falange del pie (trastorno), fractura de falange de pie, fractura de la falange del pie, fractura de falange de pie (trastorno), fractura de dedo de pie |
Japanese | 趾骨折, シコッセツ, ユビコッセツ |
Czech | Zlomený prst u nohy |
English | Fractured toe, fracture toes, fractured toe, fractured toes, fractures toe, Fracture;toe(s), fracture toe, toe fracture, fracture of toe, fractures toes, Fracture of phalanx of toe, Fracture of phalanx of toe (disorder), fracture of phalanx of foot (diagnosis), Toe fracture, Fracture of phalanx of foot (disorder), Fracture of phalanx of foot, Fracture of toe, fracture; phalanx toe, fracture; toe, phalanx; fracture toe, Fracture of phalanx of foot, NOS, Fracture of toe, NOS, fractured toe(s) |
Hungarian | Öregujjtörés |
Ontology: Fracture of great toe (C0452093)
Concepts | Injury or Poisoning (T037) |
ICD10 | S92.4 |
SnomedCT | 208719004 |
Dutch | grote teen fractuur, falanx; fractuur teen: grote teen, fractuur; falanx teen: grote teen, fractuur; hallux, fractuur; teen, grote, grote teen; fractuur falanx, hallux; fractuur, teen; fractuur, grote, Fractuur van grote teen |
French | Fracture du gros orteil |
German | Fraktur der grossen Zehe, Fraktur der Grosszehe |
Italian | Frattura dell'alluce |
Portuguese | Fractura do dedo grande |
Spanish | Fractura del dedo gordo del pie, fractura de dedo gordo, fractura del dedo gordo (trastorno), fractura de dedo gordo (trastorno), fractura del dedo gordo, fractura de hallux |
Japanese | 母趾骨折, ボシコッセツ |
Czech | Zlomenina palce u nohy |
English | Great toe fracture, great toe fracture, fracture great toe, fracture of great toe (diagnosis), fracture of great toe, Fracture of great toe, Fracture of great toe (disorder), fracture; hallux, fracture; phalanx toe: great toe, fracture; toe, great, great toe; fracture phalanx, hallux; fracture, phalanx; fracture toe: great toe, toe (toes); fracture, great |
Korean | 엄지 발가락의 골절 |
Hungarian | Nagylábujjtörés |