Toe fractures in adults
- Jocelyn R Gravlee, MD
Jocelyn R Gravlee, MD
- Clinical Assistant Professor of Community Health and Family Medicine
- University of Florida College of Medicine
- Robert L Hatch, MD, MPH
Robert L Hatch, MD, MPH
- Professor of Family Medicine
- University of Florida College of Medicine
Toe fractures are relatively common and frequently managed by primary care and emergency physicians. According to two reviews of orthopedic management in the primary care setting , broken toes account for approximately 9 percent of fractures treated [1,2]. Of these, over 60 to 75 percent involve the smaller toes [3,4]. Although often dismissed as inconsequential, toe fractures that are improperly managed can lead to significant pain and disability. Treatment is generally straightforward, with excellent outcomes.
This topic will review the evaluation and management of toe fractures in adults. Toe fractures in children and other foot injuries are discussed separately. (See "Metatarsal and toe fractures in children" and "Evaluation and diagnosis of common causes of foot pain in adults" and "Metatarsal shaft fractures" and "Sesamoid fractures of the foot" and "Overview of running injuries of the lower extremity" and "Tarsometatarsal (Lisfranc) joint complex injuries" and "Evaluation of the diabetic foot" and "Proximal fifth metatarsal fractures" and "Navicular stress fractures of the foot" and "Cuboid and cuneiform fractures".)
By convention, toes and their respective metatarsals are numbered from one (great toe) through five (little toe). The second through fifth toes typically have three phalanges, while the great toe has two. Lesser toes, especially the fifth, may occasionally have only two phalanges (figure 1A-C).
Tendons and ligaments insert at the bases of each phalanx (figure 2). The forces exerted by these structures may contribute to displacement of fracture fragments. Tendons, joint capsule, or other soft tissues may sometimes become interposed between fracture fragments, rendering them irreducible except by an open surgical approach.
The plantar digital artery and nerve pass together along each side of each toe deep to the plantar surface (figure 3). Each toe also has a pair of dorsal digital arteries and nerves (figure 2). The dorsal neurovascular structures are generally smaller and less significant than the ones on the plantar surface, but there is some variation among individuals, particularly with the first (great) toe. It is unusual for the neurovascular bundle to be injured as a consequence of a toe fracture, unless the fracture is open (eg, lawnmower injuries) or caused by a serious crush injury.
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- CLINICAL ANATOMY
- MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- DIAGNOSTIC IMAGING
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- Emergency referral
- General indications
- Great toe fractures
- Lesser toe fractures
- Non-displaced fractures
- Injury to the nail bed
- Displaced fractures
- Open fractures
- FOLLOW-UP CARE
- General guidelines
- Closed injury
- Open injury
- RETURN TO WORK OR SPORTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS