Toe fractures in adults
Date First Published:
September 9, 2011
Last Updated:
April 15, 2013
Report by:
Dr David Paradise, CT3 Emergency Medicine (Royal Sussex County Hospital, Sussex, UK)
Search checked by:
Dr Evan Coughlan, Royal Sussex County Hospital, Sussex, UK
Three-Part Question:
In [adults with toe phalanx fractures] is [intervention and follow up better than no intervention] at [reducing pain, reducing time to return to normal activity, reducing requirement for interventional surgery or improving long term pain or gait issues.]
Clinical Scenario:
A 35 year old builder presents to the emergency department having dropped a paving slab on his toes. He has swollen painful great toe on the right foot. An x-ray shows he has sustained a closed fracture of the distal phalanx of the great toe. No other injuries have been sustained.
Search Strategy:
Medline 1947 to August 2012 using the OVID interface
Search Details:
[{(toe.mp or phalanx$.mp) and (exp. Foot fracture)}.
Outcome:
Forty papers were identified one of which answered the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Demographics and functional Outcome of Toe Fractures. Vliet-Koppert ST, van Cakir H, Lieshout EMM, et al 2011 The Netherlands | All patients with toe fractures presenting to the emergency department between 2006 and 2008.<br><br> 339 patients with toe fractures, 264 who were between ages 16-75 were sent postal surveys |
Retrospective cohort with survey | Survey response | 141/264 | Retrospective cohort.<br><br>Poor response rate to survey.<br><br>Not all participants answered the midfoot score |
| Median follow up time | 27 months | ||||
| Treatment | 66/141 splinted with adjacent toe | ||||
| American Orthopaedic Foot and Ankle Society midfoot score | 120/141 could run, 106/141 could stand on toes, 116/141 could walk barefoot |
Author Commentary:
There is little published literature comparing the management of toe phalanx fractures.
Bottom Line:
There is no evidence to determine whether intervention of any type improves outcome in toe phalanx fractures. Local advice should be followed.
References:
- Vliet-Koppert ST, van Cakir H, Lieshout EMM, et al. Demographics and functional Outcome of Toe Fractures.