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Particular attention should be addressed to fractures of the Hallux or Great Toe. Since the great toe is essential for propulsion and normal gait, any joint disruption due to angular changes or arthritis can have life long implications, including pain, swelling and reduced range of motion.
Fractures of the Hallux are the most frequent injury to the forefoot (front 1/3 of the foot). These fractures are caused primarily by crush type injuries or impact (stubbing toe) trauma. Stress fractures (ballet, dance) also are major causes of this type of fracture. Secondary damage to the nail plate and nail matrix, further aggravates this already painful and swollen condition, and increases the risk of infection. Immediate treatment and correct diagnosis is mandatory to ensure proper healing of these fractures.
Most Hallux fractures involve the distal aspect or the tip of the Great Toe. These stubbing type of injuries usually are diagnosed with x-ray and treated according to the severity of the fracture. Stress fractures or non-displaced fractures usually are treated with bandages, splinting and a low top walking boot or surgical type shoe (rigid soled shoe). Displaced fractures may involve a degree of manual manipulation under local anesthesia followed by immobilization in a low top walking boot.
Crush injuries caused by blunt trauma usually require more advanced treatment. Excessive hematoma formation under the toenail requires immediate decompression. Multiple (comminuted) fractures may require surgical intervention involving internal fixation devices, followed by non-weight bearing and various immobilization devices such as a cast, cam walker or surgical shoe. Whatever the type of Hallux injury you have, it is important to recognize that there is no such thing as a simple fracture. Early diagnosis and treatment is essential to prevent long term pain and disability.
