Great Toes

Clinical Examination

Patient presents with painful great toe, mechansim consistent with axial compression injury or direct force. NOT metatarsal pain.

Clinical examination indicates an X-Ray

Closed fracture, no deformity 

 Closed fracture, relocated dislocation or growth plate fracture with NO deformity , NV intact 

Flat enclosed shoe 

Rest, Ice, Pain relief and elevation advice

Read through the great toe discharge leaflet with the patient/ parent/ guardian. Highlight safety advice

NO NPC 

Open fracture, NO joint involvement .

open fracture to the great toe, which  DOES NOT go through the joint or growth plate.

Irrigate

Antibiotic cover as per local Microguide 

wound review 2-3 days at. GP

Rest,Ice, pain relief and Elevation advice 

Well soled shoe or removable orthopaedic velcro shoe.

Diabetic patients-  ref podiatry service 

NEXT DAY NPC

Discharge with great toe leafet.

Open Fracture  Intra articular

Open Fracture dislocations going INTO the joint, extensive devitalised tissue or other immediate clinical concern

Relocate to best position

Irrigate 

apply dressing 

Antibiotic cover as per local Microguide 

Rest, Ice, Pain releif and Elevation advice

Well soled shoe or removable orthopaedic velcro shoe.

Diabetic patients-  ref podiatry service 

Discuss with On Call Trauma Reg. Bleep 1222 and treat as advised .