Q. How to correct little toe fracture?
Hi doctor,
My dad met with an accident 40 days back. His little toe was fractured, but it remains in the same position as before. The doctor suggested him to take Calcium tablets, in order to retain the toe back to normal, for a period of three months. He had undergone common dressings, but no surgery. I did not follow what the doctor said. I am confused. Kindly guide.
Hi,
Welcome to icliniq.com.
I went through your dad's clinical history and the x-ray (attachment removed to protect patient identity).
The x-ray shows fracture malunion with slight malrotation of the fifth toe.
It has been almost more than a month since the injury. Hence, kindly send me a clinical picture of the injured toe. From which I will be able to have a clear idea regarding the rotated toe and guide you accordingly.
Please attach a recent x-ray of the injured toe in anteroposterior (AP) projection as well as in oblique view, by which I can check the fracture union status of the injured toe.
Investigations to be done:
1. X-ray of the foot (AP and oblique views).
2. Clinical picture of the involved foot.
Thank you doctor,
I have sent you the recent x-ray and few pictures of the injured toe. Because of cracks present on his skin, he underwent general dressing along with massage of his toe. He is using tablet Gemcal. Is it better to wait? Or should he undergo any treatment for it? Waiting for a positive response. Kindly suggest.
Hello,Welcome back to icliniq.com.
I had a look at the x-ray and the pictures (attachment removed to protect patient identity) of your father. I do not contend with the fracture reduction as well as the position of it.
I would like to mention a few points in relation to the toe. Since it is the last toe, it does not play any important role in weight bearing. Though it is a valgus reduction, there is no significant malrotation.
Since 40 days has passed from the day of injury, if we try to correct the alignment now, it can only be done surgically using K-wire (kirschner). Functionally, a malreduction should not cause any major problem with respect to his age and if he is not much into walking.
Generally, there will be a slight swelling after ankle and foot fractures. They will gradually heal in a few days. In order to get a clear idea and check for any mobility at the fracture site, I would like you to get some stress x-rays. From the x-ray, I can check whether the fracture has consolidated or not.
It is advisable to go with reduction and fixation if there is any mobility at the fracture site. When in stress, if there is no mobility present at the injured site then it is better to start off with reduction followed by gentle mobilization using well-cushioned shoes or pneumatic boot.
In order to prevent stiffness of joints, do hot water fomentation two to three times a day. To have a healthy bone metabolism, include plenty of calcium and vitamin D containing diet.
The Probable causes:
Injury 40 days ago.
Investigations to be done:Stress x-rays to look for abnormal mobility at fracture site.
Treatment plan:Depends upon the stress x- ray.
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