Barefoot Stubbing Injuries to the Great Toe in Children

A New Classification by Injury Mechanism

Abstract

Objective: 

This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery.

Design: 

Prospective clinical series of consecutively treated patients.

Setting: 

Tertiary university hospital setting.

Patients: 

Forty-one children who had sustained an indirect injury to the great toe during barefoot sports activities between January 2001 and December 2009 were included.

Intervention: 

Conservative or surgical treatment was done according to clinical and radiological findings.

Main Outcome Measurement: 

Information regarding injury mechanism was collected from patients, parents, and coaches using skeletal models and assessed by a pediatric orthopedic surgeon. Mechanisms of injury were identified and grouped as follows: hyperabduction–flexion, hyperflexion, hyperabduction–extension, hyperextension, and hyperextension–adduction.

Results: 

Hyperabduction–flexion was the most common mechanism (n = 16), in which interphalangeal joint dislocation and skin disruption was noted in most cases. The second most common mechanism was hyperabduction–extension (n = 14) in which avulsion fracture of the lateral volar condyle of the proximal phalanx was noted in most cases. This avulsion fracture had the worst prognosis after conservative care.

Conclusions: 

Based on these results, we have created a grading system and treatment protocol for indirect hallux sports injuries in children. Avulsion fracture of the lateral condyle of the proximal phalanx, a result of hyperabduction–extension, is a high-risk sign of nonunion and should be aggressively treated, contrary to previous guidelines.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.