Miscellaneous Injuries and Protocols

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
    • Typically the patient presents with painful, swollen toe. Complains of difficulty with shoe wear and ambulation
    • Physical exam reveals swelling, erythema, and ecchymosis at the injured digit, can extend into the forefoot. Palpating the injured digit reproduces pain.
  • Diagnostic Imaging
    • 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.
    • Bone Scan: not indicated

CT Scan: Not indicated. iv. MRI: Not indicated

Treatment Based on Fracture Type

  • Lesser Digit Fractures – 2nd and 5th toe fractures
    • Extra-articular fracutres
      • Non-displaced: buddy splint with a post-op shoe or short CAM walker depending on 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.