Friday's Patient Problem of the Week: Toe Injury (Should they be checked???)

It is common knowledge, or better said "myth", that toe injuries do not have to be x-rayed because there is nothing to do anyway. It is a common misconception, and many times the wrong misconception. When I see a toe injury, I do not always take an x-ray, even when the patient feels it may be broken. I check toe position, where the pain is, joint movement, and swelling/black and blue patterns. A podiatrist typically is skilled in recognizing with that sixth sense if an x-ray is needed. In this case, the patient felt she probably did not need an x-ray, but left me a phone message to run it by me. I recommended an x-ray due to the discomfort she was having and left the order at our front desk. After she got the x-ray (I work within a hospital), she emailed me and I checked to find the first 3 images noting a dislocated 5th toe. In this type of medial dislocation, if she had tried the standard buddy taping to the fourth toe, she would have dislocated the toe further. The first 3 views below are done at the same time, only from different angles. She was immediately sent to our podiatric surgeon, Dr Remy Ardizzone, who placed the toe in the right place under local anesthesia in the office (called "closed reduction"). This is well documented in the last 2 images. Good Job!!!