MANUAL MINORS
Toe fractures are common injuries typically caused by direct trauma, such as stubbing the toe or dropping heavy objects. They can also result from twisting injuries or overuse. These fractures may be simple and non-displaced or more complex, with bone fragment displacement. Although generally not severe, they can cause intense pain, swelling, and temporary difficulty in walking.
Diagnosis
Diagnosis is based on the history of trauma, accompanied by sharp pain, swelling, bruising, and possible visible deformity of the affected toe. Physical examination may reveal localised tenderness and difficulty in moving or bearing weight on the injured toe. Anteroposterior and lateral X-rays are essential to confirm the diagnosis and assess the severity of the fracture, including any displacement or joint involvement.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Toe sprain | Ligament injury with pain and swelling, but no visible bone fracture on X-rays. |
Toe contusion | Pain and bruising without bone fracture or visible deformity. |
Toe dislocation | Visible joint displacement without bone fracture. |
Gout | Intense pain in a toe joint, often with chronic inflammatory signs. |
Emergency Management
In the emergency setting, initial management includes immobilisation of the affected toe using “buddy taping” (taping it to the adjacent toe) if the fracture is simple and non-displaced. Rest, ice application to reduce swelling, and analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for pain relief.
For more severe or displaced fractures, closed reduction and immobilisation with a splint or a rigid orthopaedic shoe may be required. Follow-up X-rays should be taken after reduction.
Definitive Treatment
Most toe fractures are managed conservatively with immobilisation and reduced physical activity for 4-6 weeks to allow proper healing. In cases of displaced, unstable, or joint-involved fractures, surgical intervention may be necessary to align the bone fragments using screws or plates. Post-fracture rehabilitation may involve mobility and strengthening exercises to restore full foot function.
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