The patient is placed supine on a radiolucent table. A well-padded bump is placed under the ankle and heel of the surgical foot to elevate the foot for improved access and stabilize against rotation.
The nonoperative leg is secured with safety straps or taping.
To correct for external rotation of the leg and foot, a well-padded bump may be placed under the ipsilateral hip (a).
Alternatively, to correct for internal rotation of the leg and foot, a well-padded bump is placed under the contralateral hip (b).
2. Nonoperative treatment
Nonoperative treatment involves manual reduction, buddy taping and rigid-sole shoe until non-tender.
3. Closed reduction and K-wire fixation
Operative treatment involves manual reduction and percutaneous 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 finishes in the proximal phalanx metaphyseal region proximally.
Fluoroscopic assistance during this procedure is necessary.
After percutaneous pinning immobilize the foot in a flat, rigid sole shoe until the K-wires are removed at six weeks.
If the toes were buddy taped then the same shoe may be worn.