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Evaluation and management of toe fractures
Robert L Hatch1, Scott Hacking
1Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA. hatch@dean.med.ufl.edu
American Family Physician
|January 7, 2004
Summary
Toe fractures, often caused by crushing injuries, are common. Diagnosis uses X-rays, and treatment ranges from buddy taping for stable fractures to referral for severe cases like first toe fractures.
Area of Science:
- Orthopedic Surgery
- Family Medicine
- Radiology
Background:
- Toe fractures are common lower extremity injuries frequently diagnosed by family physicians.
- Most toe fractures result from crushing injuries or axial forces, like stubbing a toe.
- Less common causes include joint hyperextension and stress fractures.
Purpose of the Study:
- To outline the diagnosis and management of toe fractures.
- To identify criteria for referral to specialists.
- To guide family physicians in treating common toe fractures.
Main Methods:
- Review of diagnostic imaging, primarily anteroposterior and oblique radiographs.
- Clinical assessment for point tenderness and pain with axial loading.
- Evaluation of fracture displacement, joint involvement, and soft tissue status.
Main Results:
- Radiographs are key for identifying fractures, displacement, and assessing adjacent structures.
- Referral is necessary for open fractures, circulatory compromise, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or unstable first toe fractures.
- Nondisplaced Salter-Harris type I and II physeal fractures in children may be managed by family physicians.
Conclusions:
- Stable, nondisplaced toe fractures are treated with buddy taping and rigid-sole shoes.
- Displaced lesser toe fractures require reduction and buddy taping.
- Displaced first toe fractures often necessitate specialist referral for stabilization.