What are lesser toe (phalangeal) fractures
As the name implies a phalangeal fracture involves a fracture of any of the bones in the lesser toes. Fractures can affect:
|The proximal phalanx||The intermediate phalanx||The distal phalanx|
Causes of lesser toe (phalangeal) fractures
Trauma (generally something heavy landing on the toe or kicking an immovable object)
Treatment of lesser toe (phalangeal) fractures
A non-displaced fracture is a fracture where the two ends of the bone are still well aligned.
Initial management of non- displaced lesser toe fractures includes buddy taping to an adjacent toe, use of a rigid-sole shoe, and weight bearing as tolerated. (1)
Initial follow-up should occur within one to two weeks, then every two to four weeks for a total healing time of four to six weeks. (1)
A displaced fracture is a fracture where the two ends of the bone are no longer aligned.
Treatment of this fracture requires the bones to be manipulated back into position (reduction of the fracture). This is done under local anaeasthetic.
Once the toe has been reduced, X-rays are required initially to ensure that the displaced toe is aligned and the toe is buddy tapped to the adjacent toe to maintain position.
Referral to an orthopaedic foot and ankle surgeon
Although referral rarely is required for patients with fractures of the lesser toes, referral is recommended for patients with open fractures, fracture-dislocations, displaced intra-articular fractures, and fractures that are difficult to reduce.
Referral is recommended for children with fractures involving the apophysis.
Complications of lesser toe (phalangeal) fractures
A complication of toe fractures is persistent pain.
Pain that persists longer than a few months may indicate malunion, which may limit a patient’s future activities significantly.
Toe fractures, especially intra-articular fractures, can result in degenerative joint disease.
- Hatch RL, Hacking S. Evaluation and management of toe fractures. Am Fam Physician. 2003;68(12):2413-8.