Progressive Displacement in Proximal Phalanx Fracture of Great Toe: A 6-Week Follow-up Case
Case at a Glance
A 36-year-old female with fibromyalgia and non-radiographic axial spondyloarthritis presented with a displaced intra-articular fracture of the proximal phalanx of the left great toe following a fall. Six-week follow-up imaging revealed increased displacement and possible additional fracture lines.
Patient's Story
The patient sustained injury to her left great toe after falling off a curb. She initially delayed seeking medical attention due to previous negative experiences with healthcare visits related to her fibromyalgia. The day after injury, she was required to attend a disability evaluation that included walking on heels and toes, which exacerbated her pain. She subsequently sought medical care and imaging confirmed a fracture.
Initial Assessment
Plain radiographs revealed an intra-articular fracture at the distal end of the proximal phalanx of the left great toe with 2mm displacement. The patient was fitted with a protective boot and referred to podiatry for specialized care. Physical examination showed localized pain, swelling, and functional limitation.
The Diagnostic Journey
Initial podiatry consultation confirmed the fracture and recommended conservative management with protective footwear and activity modification. The patient was scheduled for 6-week follow-up imaging. During the healing period, she experienced ongoing challenges with household pets causing re-injury to the affected toe, along with persistent pain at the nail base and visible swelling.
Final Diagnosis
Intra-articular fracture of the proximal phalanx of the left great toe with progression to increased displacement at 6-week follow-up. Additional fracture lines suspected on follow-up imaging require further radiological interpretation.
Treatment Plan
Conservative management was initially attempted with protective boot immobilization. Given the increased displacement seen on 6-week follow-up imaging, reassessment of treatment approach is indicated. Surgical intervention may be considered depending on final radiological interpretation and clinical symptoms.
Outcome and Follow-up
At 6 weeks post-injury, the patient reports subjective improvement in pain and appearance compared to initial presentation, though not yet returned to baseline. Objective findings include persistent swelling, skin changes, and intermittent pain. Follow-up appointment scheduled with podiatry to review new imaging findings and determine if treatment modification is necessary. Patient has concerns about potential impact on upcoming cross-country travel plans.