Figure 1. Anteroposterior radiograph of the left small toe.
Figure 2. Lateral radiograph of the left small toe.
An 11-year-old girl presents to the office with pain in the left small toe after kicking a door jam. Anteroposterior and lateral radiographs show a displaced fracture of the proximal phalanx.
What is the best treatment option?
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Fracture of a phalanx of the foot is a common injury seen in urgent care and the emergency department. These fractures generally occur from a crush injury or stubbing the toe. Phalangeal fractures of the foot rarely require surgery. Surgical indications include unstable rotational deformities, irreducible fracture dislocations, and severely contaminated open fractures. Rotational deformity can be observed by comparing the injured toe with adjacent toes or those of the contralateral foot. Angulated or rotational deformities of the toe usually can be reduced and held in place by buddy taping the injured toe to an adjacent toe. Postreduction radiographs with tape in place should be performed. Residual displacement after taping is often acceptable if the toe is not deformed clinically. Further treatment is determined by examining the appearance of the toe in relation to the neighboring toes, not by radiograph. A weight-bearing boot or hard-soled shoe should be used for 3 to 4 weeks. Emphasis on heel walking is advised to avoid pushing off with the forefoot. Patients with intra-articular fractures should be advised that the toe may be more painful and stiff as post-traumatic arthritis may develop over time.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003;68(12):2413-2418.
2. Early JS. Fractures and dislocations of the midfoot and forefoot. In Heckman JD, Court-Brown C, Tornetta P, Koval JK, Bucholz RW, eds. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006;2391-2392.