Lesser Toes

Patient presents with painful lesser toe, mechanism consistent with axial compression injury or direct force.

NOT metatarsal pain

•  If the injury is closed and there is NO clinical deformity to the toe
• NV Intact
• NO X-RAY  INDICATED
• Buddy strap,to the next good toe
• Rest, Ice, pain relief and elevation advice
• Well soled shoe
• Read through the lesser toe injury discharge  leaflet with the patient, parent, gardian / carer
• Highlight safetynet advice
• Discharge  NO NPC 

•  X-Ray required due to clinical deformity 
• Open fracture to the toe, which DOES NOT go through the joint or the growth plate 
• Irrigate  and dress the wound 
• Antibiotic Cover. as per local Microguide
• Wound review 2-3 days at GP.
• Buddystrap to the next good toe.
• Rest, Ice, pain relief and Elevation advice
• Well soled shoe
• Diabetic patients - ref podiatary service Via EPR
• NO NPC
• Read through lesser toe injury advice leaflet, highlight safety net advice and NPC phone number if necessary .
• Discharge  

Open Fracture Discloctaion intrarticular 

• Open fracture disloactions going INTO the Joint, extensive devitalised tissue or other immediate clinical concern
• Irrigate  and dress the wound 
• Antibiotic Cover. as per local Microguide
• Buddystrap to the next good toe.
• Rest, Ice, pain relief and Elevation advice
• Well soled shoe
• Diabetic patients - ref podiatary service Via EPR
• Discuss with the On Call Trauma  Reg. , bleep 1222 follow the appropriate management plan.