Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Toe Fractures


Broken Toe

       
  Picture toe fracture    

A broken toe or toe fracture is a common injury, usually caused by dropping a heavy object on the foot or hitting or catching the toe on something. It usually takes four to six weeks to heal.

If you're not sure whether the toe is broken or just badly injured, don't worry - in most cases, a painful and swollen toe caused by an injury should be cared for at home, regardless of whether or not it is broken.

If the break is severe and the toe bone has broken and has become deformed at an angle, this will need to be moved back into place - a procedure known as reduction. You will be given an injection of local anaesthetic to numb the area and Dr Bhargava can often realign the broken bone through the skin without making any cuts. Usually, padding the toe and wearing an open toed sandal or shoe without any pressure on the toes is all that is required. In a few weeks the swelling and pain will subside. 

       
 
Open Fracture of Big Toe
   
       
Open fracture of Big Toe
 
Fractures of the big toe occur when heavy objects are dropped onto the toe. This can cause quite severe crushing of the toe, the toenail and the bone. This can be terribly painful. A big toe fracture may need to be supported in a cast. If a lot of blood is trapped underneath the toenail and it is very painful a small operation may be needed. This involves draning the blood out through a small hole made in your nail, or the nail will need to be removed.
 
Haematoma due to Toe Distal Phalynx Fracture
   

You may be given crutches so you can walk without putting weight on the toe.
A broken toe bone that has pierced the skin and damaged the surrounding tissue may become infected, so the wound will need to be cleansed regularly.

Fractures of the Metatarsals 

Metatarsal fractures are the most common traumatic foot injuries. There are five Metatarsal bones in each foot. They are the relatively long bones which are located between the 'Tarsal' bones of the hind-foot and the 'Phalanges' bones in the toes.

The first metatarsal is the most important and fractures of the first metatarsal usually require surgery. Fractures of the middle metatarsals (the second, third and fourth) do not require surgery unless there are significant displacements of the bone. 

 
Metatarsals
The metatarsals of the foot. These are the bones that connect the toes to the middle bones of the foot. The first metatarsal (1) connects to the big toe, and the 5th metatarsal to the baby toe.  
 

Each metatarsal is divided anatomically into different segments (the head and neck, the shaft, and the base). The treatment of these fractures depends on where the metatarsal bone is fractured. 

The 5th Metatarsal is divided into four anatomic segments (the base, the junction of the base and the shaft, the shaft, and the neck) and different types of fracture can occur at each segment.

Injuries to the metatarsals are sustained in many different ways ranging from minor twisting to falls and injuries sustained when heavy objects fall on the foot and literally crush the metatarsals.

Fractures of the fifth metatarsal are the most common out of all metatarsal fractures. Fractures of the base of the 5th Metatarsal are the most common fifth Metatarsal injuries, and occur as a result of a twisting injury of the foot or ankle. The ankle rolls inward and there is a strong ligament that attaches to the base of the Metatarsal which pulls off a small bone fragment. This type of fracture is invariably treated without surgery, and immediate walking in a removable boot or plaster cast is ideal.

 
Base of fifth metatarsal fracture
 
X-ray showing Base of fifth metatarsal fracture
 

Overuse can cause stress fractures of the Metatarsals. These fractures are common in army recruits as well as sporting individuals and are commonly known as 'march' fractures. The patient will normally report about two weeks of gradually increasing pain in the region before an incident 'converts' the stress fracture to a full fracture. The second Metatarsal is the most commonly affected, but the fifth Metatarsal can also be affected. While the stress fracture of the second Metatarsal usually heals well, the healing of a stress fracture to the fifth Metatarsal can be more problematic.

The fracture treatment of the metatarsals varies depending on the injury. For most patients a short leg walking cast for 3 weeks is enough. Surgery is reserved for the more serious of these fractures. These are usually certain types of fractures of the first and fifth metatarsal or symptomatic nonunions. 

Jones fracture

The junction between the base of the Metatarsal and the shaft is the area which creates most problems when fractured. The reason for the difficulty is that bone healing relies upon a good circulation, and this particular area of the bone has a notoriously poor blood supply.

Plaster treatment of jones fracture can take eight to ten weeks for this fracture to heal and it is not always predictable whether or not full healing will occur. If a cast or boot is used, no walking on the foot is permitted for about 6 weeks. The results of bone healing are unpredictable. Studies have shown about 70% heal with cast treatment. 

 
X-ray showing Jones Fracture
 
X-ray after fixation of Jones Fracture
 

On the other hand, surgery for the Jones fracture has about a 95% success rate. Therefore, surgery is preferable for most Jones fractures. In this treatment, a tiny puncture is made in the skin on the outside of the foot and a screw is inserted. An x-ray monitor is used to help position the screw. The screw helps speed up the healing process. Healing occurs quite rapidly and walking on the foot (with a removable boot) is permitted within a few days after surgery. Patients may return to walking and running approximately six weeks after this type of surgery. 

Another rare situation is painful non-union of stress fracture of metatarsal. As mentioned before stress fractures are common in runners. Rarely because of continued running they go into non-union and require operation.

 
Nonunion of 3rd Metatarsal Fracture
 
Union of 3rd Metatarsal Fracture after fixation