Fractures of the Toes
Toe fractures are common ("Bedroom Fractures" from stubbing in the dark) but can be debilitating. The Great Toe bears 50% of body weight during push-off and requires more aggressive management.
1. Hallux (Great Toe) Fractures
- Importance: Critical for gait (Windlass mechanism).
- Management: Intra-articular or displaced fractures need Anatomic Reduction (Screw/Pin). Undisplaced treated with stiff-soled shoe/Walking boot.
2. Lesser Toe Fractures
- Mechanism: Stubbing (Abduction injury) or heavy object drop (Crush).
- Management: Buddy Taping (strapping injured toe to neighbor) + Hard sole shoe for 3-4 weeks. Reduction is rarely needed unless deformity is gross.
3. Sesamoid Fractures
- Location: Under the 1st Metatarsal head (within FHB tendon).
- Diagnosis: Differentiate from bipartite sesamoid (smooth edges).
- Treatment: Offloading (metatarsal pad/bar).
25 Practice MCQs
Q1. The Great Toe bears approximately how much weight during gait?
Answer: A). Crucial for push-off.
Q2. Standard treatment for undisplaced lesser toe fracture is:
Answer: A). Neighbor toe acts as a splint.
Q3. Intra-articular fracture of the Great Toe IP joint requires:
Answer: A). Stiffness here is disabling.
Q4. "Bedroom Fracture" is caused by:
Answer: A). Usually abduction injury of 5th toe.
Q5. Sesamoids are embedded in which tendon?
Answer: A). Medial and lateral sesamoids.
Q6. Subungual Hematoma is managed by:
Answer: A). Relieves pressure immediately.
Q7. Turf Toe is:
Answer: A). Common in football on artificial turf.
Q8. Bipartite Sesamoid differs from fracture by:
Answer: A). Fracture shows sharp, irregular radiolucency.
Q9. Which nerve supplies sensation to the 1st web space?
Answer: A). Can be injured in trauma.
Q10. Open toe fractures are often:
Answer: A). Require antibiotics and washout.
Q11. Malunion of lesser toes is:
Answer: A). Function > Anatomy for lesser toes.
Q12. Cotton wool is placed between toes during buddy taping to:
Answer: A). Moisture builds up quickly.
Q13. Hallux Rigidus is a late complication of:
Answer: A). Stiffness of 1st MTP.
Q14. Dislocation of the IP joint is reduced by:
Answer: A). Usually snaps back easily.
Q15. A stiff-soled shoe (Post-op shoe) helps by:
Answer: A). Acts like a splint.
Q16. Sesamoid fracture healing is:
Answer: A). May require excision if painful non-union.
Q17. Which sesamoid is more commonly fractured?
Answer: A). Bears more weight.
Q18. Nail bed laceration with fracture requires:
Answer: A). Prevents osteomyelitis and nail deformity.
Q19. Comminuted Great Toe fracture ("Pilon" type) is treated with:
Answer: A). Maintains space for healing.
Q20. Fracture of the 5th toe proximal phalanx often results in:
Answer: A). May need reduction if severe.
Q21. "Sand toe" is:
Answer: A). Beach volleyball injury.
Q22. Most common complication of buddy taping is:
Answer: A). Keep dry!
Q23. Sesamoidectomy is:
Answer: A). Last resort; risks cock-up deformity or hallux valgus.
Q24. Time to union for toes is:
Answer: A). Heals fast.
Q25. Are crutches needed?
Answer: A). Heel walking is often possible.
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