Getting the Toe Out of a Jam

Toe jam injuries are extremely painful because the feet have sensitive parts and a delicate anatomy. Patients, especially women, care about cosmetic results. EPs should consider the emergency concerns of foot wound closure and cosmetic results when attempting repair. More importantly, patients with neuropathies, diabetes, and vascular diseases warrant close attention to detail to prevent complications. High-risk patients can develop serious infections, which could result in the loss of a toe or limb. It might be excessive to call a plastic surgeon to consult on a foot wound, but it may be appropriate to consult podiatry or vascular.A simple toe jam injury with a linear laceration. Photo by M. Roberts.Toe jam injuries do not always require radiographic imaging. Simple cuts and lacerations should be irrigated and elevated in the emergency department. Crush or severe impact injuries need three or four plain-film radiographic views of the foot and toe to rule out fractures. Pay particular attention to fractures to the fifth metatarsal, navicular bones, and joint spaces, finishing your exam using a step-wise approach. (J Emerg Med. 2002;22[2]:163.) The tendons and ligaments should be tested for strength and mobility. Cleaning the feet with soap and water is critical, as is using chlorhexidine prep or Betadine swab before anesthetizing the area. Soaking the foot in a bath of Betadine is discouraged.Studies have shown that normal saline is as effective as Betadine in decreasing ...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs