Nonoperative treatment may involve manual reduction, buddy taping and hard-sole shoe until non-tender.
2. Closed reduction and K-wire fixation
Surgical treatment involves percutaneous pinning across the MTP joint to maintain alignment and stability. In rare cases, open debridement of bone fragments from the joint prior to pinning is required.
This procedure is normally performed with the patient in a supine position.
Manual traction and pinning
Manual traction is applied on the toe. A 1.25 mm or 1.6 mm K-wire is then placed into the tip of the toe just plantar to the nail, across the DIP and PIP joints, and reduced MTP joint.
Fluoroscopic assistance during this procedure is necessary.
Fixation following debridement
If debridement of bone fragments from the joint is required, a dorsal approach to the MTPJ may be utilized prior to pinning. Loose bodies are removed and the joint is irrigated.
In this case, the double ended K-wire may be inserted retrograde into the proximal phalanx exiting the tip of the toe, and anterograde into the corresponding metatarsal head and shaft.
Weight bearing may be allowed as long as the patient is provided with a flat, rigid sole shoe which is continued for 6-10 weeks, until X-rays or clinical examination is consistent with healing.
To prevent stiffness, range of motion for the first MTP joint is initiated at two weeks.
The toe is then splinted or taped for an additional 6 weeks to prevent dorsal subluxation of the joint.