Broken or dislocated toe

[Hot Holster]

Tape it to the toe next to it. Stiff-soled shoes may make it easier to walk. That's likely all they'd do at urgent care.

+1, unless it broke a bone in the foot, the most they will do is tape it.

[Ttwwaack]

Just make sure the tape is secure. My pinkey on my left foot is straight but twisted 1/4 turn. It works and is there, causes no pain but woman with a foot fetish linda get put off.

[officerX]

No pic, no care.











LOL

[Sensei]

A little Versed, a little Fentanyl, 1..2..3..grit your teeth for a moment...done.

If you think that I'm going to spend an hour completing procedural sedation paperwork (thank you Joint Commission) and jumping through the hoops for a pinky toe, then you are out of your f-ing mind. Real men take the pain. It puts hair on the chest.

[texasgunhand]

If it doesnt turn black and you can move it,, Just rub some dirt on it and walk it off.

Tape it to the next one,and take it easy..Thats about all you can do but spend money and get pain pills. But if it turns black and you cant move it,go to the DR.

[Hmac]

If you think that I'm going to spend an hour completing procedural sedation paperwork (thank you Joint Commission) and jumping through the hoops for a pinky toe, then you are out of your f-ing mind. Real men take the pain. It puts hair on the chest.

We're also Joint Commision, but the paperwork for moderate sedation is quite simple around here.

Some posters here are overthinking the issue. We're talking about the 5th toe. Functional disability from a fracture or fracture/dislocation is negligible. Diagnosis and treatment of such an injury isn't something that warrants a lot of time or expense.

[Sensei]

We're also Joint Commision, but the paperwork for moderate sedation is quite simple around here.

Some posters here are overthinking the issue. We're talking about the 5th toe here. Functional disability from a fracture or fracture/dislocation is negligible. Diagnosis and treatment of such an injury isn't something that warrants a lot of time or expense.

Those days are over at every hospital where I work. Moderate sedation (ketamine or benzo + opiate) means at least 5 pages of assessment, consents, and recovery paperwork. It also ties me up for 15-20 minutes, as well as a nurse and a respiratory therapist for about 30 minutes. Deep sedation (propofol or etomidate) is much worse because it requires 2 physicians - 1 for the sedation and another for the procedure. Thank you Michael Jackson. Actually, I doubt that the King of Pop had anything to do with it, but that was when hospitals started really cracking down.

Reducing a toe or finger dislocation is stupid easy. Simply pull. It will hurt for a second or two and then feel much better. Subjecting someone to the risks of sedation (granted very small) and the costs (about $1000) for such a simple procedure would raise some eyebrows in my neck of he woods.

[Hmac]

I've never even applied for deep sedation (propofol) privileges. I just have them call an anesthetist if that's required. Moderate sedation (narcotic+benzodiazapine) is pretty routine and poses little inconvenience to me from a paperwork standpoint the way we have it set up. Most of my use of propofol sedation is done in surgery or endoscopy, however. I occasionally use moderate sedation in the ER or ICU, but generally speaking, if a surgeon is required for something in the ER or ICU then we're usually talking about a procedural magnitude that warrants propofol.

[Sensei]

Another trick is to simply put an ice pack on the affected finger or toe for about 30 min. That will provide some local anesthesia before applying longitudinal traction. If it is a little toe, all you need to do is buddy tape it to the 4th toe. There is no real need for x-rays if you are healthy and get reasonable anatomic alignment. Personally, I like to get all wide-eyed and crazy like Martin Riggs right before I pull on it - I think it make the patients feel more at ease. When it pops into place, I celebrate with a loud, Rick Flair "WOOOO!"

Fingers 2-5 get a little more tricky. This is especially true if there is an intra-articular fracture that prevents full extension or tendon disruption. Thus, I do recommend an x-ray and ortho referral for all finger dislocations that are persistently unstable after reduction or that do not achieve full range of motion after 1-2 days of immobilization.

When it comes to the thumb - all bets are off. See a doctor if you have any deformity or loss of movement. After all, the ability to perform thumb opposition is vital to most people's career (it basically distinguishes me from a panda bear). There are plenty of ligamentous injuries such as a Game Keepers Thumb that require operative repair. Then, there are fractures to the thumb metacarpal (Bennett's and Rolando's) that may require pinning to get a good functional outcome. In addition, thumb pain may also be associated with scaphoid injuries that are at risk for AVN/non-union if you do not adequately immobilize it. Bottom line, don't be cheap with your thumb or your hand - it will cost you in the long run.

[Hmac]

Finger fractures are completely different than toes in terms of functionality goals.