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Protocols for Injuries to the Foot and Ankle




  • Background
    Digital fractures commonly occur in the workplace and are usually the result of a crush injury from a falling object, or from striking one’s foot against an immobile object (stubbing one’s toe). There is a wide range of digital fractures, from simple non-displaced fractures requiring stiff soled shoe wear, to comminuted compound intra-articular fractures requiring emergent surgical debridement and stabilization. Minimizing digital fracture occurrence should be the primary goal in the workplace, and the steel toe “safety shoes” have significantly reduced the incidence of these injuries.
  • Diagnostic Criteria
    1. History and Physical Examination:
      1. Typically the patient presents with a painful, swollen toe. The patient often complains of difficulty with shoe wear and ambulation.
      2. Physical exam reveals swelling, erythema and ecchymosis at the injured digit, which can often extend into the forefoot. Palpating the injured digit reproduces pain.
    2. Diagnostic Imaging:
      1. Plain Radiography: Standard anteroposterior (AP), oblique, and lateral radiographs of the entire foot should be obtained to not only include the toe, but the entire foot as injuries more proximal are common.
      2. Bone Scan: Not indicated.
  • CT Scan: Not indicated. iv. MRI: Not indicated.
  • Treatment Based on Fracture Type:
    1. Lesser Digit Fractures – 2nd and 5th toe fractures
      1. Extra-articular fractures
        • Non-displaced: Buddy splint with post op shoe or short CAM walker depending on patient comfort level for 2-4 weeks.
        • Displaced: Closed reduction under digital anesthetic block followed by buddy splint, post-op shoe, or short CAM walker boot for 4- 6 weeks.