Marie Bamer

Those fractures involving the great toe or any of the lesser toes, metatarsals, or sesamoid bones.

Phalangeal Metatarsal Sesamoid

Phalangeal Fractures: can involve the neck, shaft, or base of the bone

MOI:Results from a direct trauma or avulsion mechanism

*fx of 1st from being hit with an axe

Metatarsal Fractures: Fx of a metatarsal

MOI: fractures of the 1st- 4th usually result in direct trauma. 2nd -5th may occur as result of a twisting injury

* Jones Fx- proximal 5th metatarsal shaft

Sesamoid Fractures: splitting or fragmentation of one or both of the two small bones contained within the tendon of the flexor hallicus longus

MOI: often secondary to the impact of the foot on a hard surface while toes are dorsiflexed.

*A) Comminuted fx B) Post-op resection of bone

Orthopaedic Objectives Anatomical alignment of the great toe, phalanx,

metatarsal and sesamoid is essential in weight bearing and load distribution on the foot.

Alignment of the 2nd- 5th metatarsals is important to minimize problematic gait and painful fitting of shoes

Forefoot stability is important to maintain stable and pain-free gait

Rehabilitation Objectives

Range of Motion-restore and maintain all ROM

Muscle Strength- improve and restore strength of extensors, flexors, invertors, and evertors in foot

Functional Goals- normalize gait to pre-injury pattern

Lesser Phalanx Fx: 4 to 6 weeks 2nd, 3rd and 4th Metatarsal Fx: 4 to 6 weeks

5th Metatarsal Fx ( Jones Fx): 6 to 8 weeks

Great Toe Phalanx Fx: 4 to 6 weeks

1st Metatarsal Fx: 6 to 8 weeks

Sesamoid Fx: 4 to 8 weeks

Lesser Phalanx Fx: 2 to 6 weeks 2nd, 3rd and 4th Metatarsal Fx: 4 to 6 weeks

5th Metatarsal Fx (Jones): 4 to 6 weeks (acute), 6 to 10 for delayed union, nonunion, or stress fx

Great Toe Phalanx Fx: 4 to 6 weeks

1st Metatarsal Fx: 4 to 6 weeks

Sesamoid Fx: 8 to 12 weeks, possibly longer after sesamoidectomy

Lesser Phalanx Fx

Splints or Buddy Taping

Open Reduction and Percutaneous PinningK –wires and short leg cast for 2-3 weeks

*distal phalanx of 5th

2nd, 3rd, 4th Metatarsal Fx

Cast-short leg walking *if undisplaced or minimally

displaced Closed Reduction and

Percutaneous Pinning*closed, displaced or angulated fx-

NWB cast for 2-3 weeks

Open Reduction and Internal Fixation

*open, displaced- NWB cast for 2-3 weeks

* 2nd MT

5th Metatarsal Fx (Jones)

Cast/Splint• Acute avulsion=walking boot if

displacement is less than 2 mm• Jones of proximal end= NWB cast Open Reduction and Internal

Fixation• Avulsion of greater than 2 mm=

tension-band wire or lag screw • Delayed or non-union require

intramedullary screw• NWB cast approx 6 weeks

Great Toe Phalanx Fx

Cast- NWB extended to toes Closed Reduction and Percutaneous Pinning or Open Reduction

and Internal Fixation

1st Metatarsal Fx

Cast Open Reduction and Internal Fixation

Sesamoid Fx

Cast/ Splint Sesamoidectomy

Day of injury to 1 week

Stability of fx site: None Stage of Bone Healing: Inflammatory

phase Radiograph: No callus

* NWB, check cap refill, no deformities, radiograph,

Two Weeks

Stability of fx site: None to minimal Stage of bone healing: Begins reparative

phase Radiograph: No change or early callus

Four to Six Weeks

Stability of fx site: Bridging callus and fx usually stable (acute fx)

Stage of bone healing: reparative phase Radiograph: Bridging callus visible

Six to Eight Weeks

Stability of fx site: Fx stable with bridging callus

Stage of bone healing: reparative phase Radiograph: Bridging callus visible w/

increased ridgidity. Fx line less distinct

Eight to Twelve Weeks

Stability of fx site: Stable Stage of bone healing: Remodeling Phase Radiograph: abundant callus

Age – elderly at higher risks for joint stiffness

Articular Involvement- any fx in forefoot requires anatomic reduction

Location Open Fractures- all must be treated

aggressively with irrigation, debridement, and intravenous antibiotics