![]() ![]() ![]() Displaced fracture fragment requires open fixation. Luckily, most patients can compensate and adapt to some stiffness in this joint if the remainder of the foot has normal mobility. Due to the crush mechanism of injury, the clinician should check carefully for nailbed lacerations and a subungual hematoma.įractures that extend into the first metatarsophalangeal (MTP) joint space will often lead to chronic stiffness of the MTP joint. These should be immobilized with a CAM walker-a high-top walking boot-for two to three weeks before converting to a rigid shoe.īecause of their anatomic importance, displaced frac- tures of the proximal phalanx need to be fixed with a K wire and should be referred to orthopedics or podiatry. However, transverse frac- tures through the proximal phalanx are more trouble- some. The strong flexor tendons on the plantar surface of the toe may cause the fracture to displace and lead to chronic deformities and shoe-fitting problems if not fixed properly.Ī simple, nondisplaced fracture of the distal phalanx can be treated with buddy taping of the toes for two to three weeks and a post-op shoe. The first ray is essential to proper ambulation, especially during toe push off.įractures of the hallux commonly occur from a direct blow to the foot. The great toe, or hallux, and its metatarsal are anatom ically distinct from the rest of the forefoot and are designated as the first ray. ![]() In this first installment, we will discuss fractures of the toes, meta tarsals, and Lisfranc joint (tarsal-metatarsal joints) the second will appear in the January issue of JUCM and focus on injuries, particularly fractures, to the cuboid, cuneiforms, navicular, talus, Chopart joint, and calcaneus, as well as compartment syndrome. Our examination of foot fractures in urgent care will be divided into two parts. For example, young families in suburban areas are more likely to present with forefoot fractures and stress fractures in more urban or industrial environs, urgent care clinicians are more likely to see injuries resulting from motor vehicle accidents or high-energy trauma leading to fractures and dislocations of the more rigid midfoot and hindfoot. The scope of foot fractures seen in the urgent care setting varies by locale and demographics of the patient population. The role of the urgent care clinician in patients with other significant fractures, the vast majority of whom will need to be referred to orthopedics for definitive care this will include pitfalls to avoid in the acute assessment and management of these patients. Proper management of and follow-up for simple nondisplaced fractures in the foot.Ģ. This article will focus primarily on two aspects of care:ġ. Understanding the natural history of untreated fractures in the foot is imperative to positive outcomes. Urgent message: Acute injuries to the foot often send patients to an urgent care center-though on occasion they don’t present for weeks, or even months, after the injury occurred. ![]()
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