the Pros and Cons of Surgery for a Fractured Fourth Toe

Fracture of the fourth toe of the right foot?

Hello Doctor: I was in a car accident on March 3rd and fractured the fourth toe on my right foot.
The fracture extends to the joint surface and is slightly displaced.
I have seen two doctors, both of whom told me that surgery is an option, but not necessary.
The reasoning is that the fourth toe does not bear much weight and the impact is minimal.
However, they mentioned that if I choose to have surgery, it could reduce the risk of future arthritis (although they also noted that there is still a risk of arthritis even after surgery).
I asked if not having surgery would affect the appearance or range of motion, and the doctors indicated that it should not have an impact, but the joint surface would not heal in the same way without surgery (it has been 26 days since the injury, and the X-ray still shows a missing fragment; the fracture is located at the lower left corner of the fourth toe near the web space.
Since the accident, I have only used breathable tape to stabilize the 2nd, 3rd, and 4th toes, and I have been wearing a pneumatic ankle brace while out).
I would like to ask the doctor about the pros and cons of surgery versus non-surgery in this situation and any recommendations you may have.
Thank you!

Da Bao, 40~49 year old female. Ask Date: 2023/03/30

Dr. Shi Guozheng reply Orthopedics

A fracture of the fourth toe can often heal without the need for surgery.

Reply Date: 2023/03/30

More Info

When considering whether to undergo surgery for a fractured fourth toe, there are several factors to weigh, including the nature of the fracture, potential long-term outcomes, and the risks associated with surgical intervention.

Pros of Surgery
1. Alignment and Healing: Surgery can help realign the fractured bone segments, especially if there is displacement. Proper alignment is crucial for optimal healing and function. If the fracture involves the joint surface, surgical intervention may be necessary to ensure that the joint heals correctly, potentially preventing future complications.

2. Reduced Risk of Arthritis: As mentioned, one of the advantages of surgical intervention is the potential to lower the risk of developing post-traumatic arthritis. Misalignment or improper healing of the joint surface can lead to abnormal wear and tear, resulting in arthritis over time. Surgery can help mitigate this risk by ensuring that the joint surfaces are properly aligned.

3. Improved Functionality: If the fracture is significantly displaced or involves the joint, surgery may improve the overall functionality of the toe. This is particularly important for individuals who are active or rely on their feet for work or daily activities.

4. Pain Management: In some cases, surgery can alleviate chronic pain associated with improperly healed fractures. If the toe does not heal correctly, it may lead to ongoing discomfort that could be resolved through surgical intervention.

Cons of Surgery
1. Surgical Risks: As with any surgical procedure, there are inherent risks, including infection, bleeding, and complications related to anesthesia. Additionally, there is a risk that the surgery may not achieve the desired outcome, leading to further complications.

2. Recovery Time: Surgery typically requires a longer recovery period compared to conservative treatment. This may involve immobilization, physical therapy, and a gradual return to normal activities. For some individuals, this can be a significant drawback, especially if they have a demanding lifestyle.

3. Cost and Resources: Surgical procedures can be costly, and depending on your insurance coverage, this may be a significant factor to consider. Additionally, the need for follow-up appointments and potential rehabilitation can add to the overall cost.

4. Potential for Future Issues: Even with surgery, there is no guarantee that complications will not arise in the future. For example, there may still be a risk of developing arthritis or other joint issues, even if the surgery is successful.

Non-Surgical Considerations
1. Conservative Management: If the fracture is stable and not significantly displaced, conservative management may be a viable option. This typically involves immobilization, rest, and possibly physical therapy. Many fractures heal well without surgery, especially in non-weight-bearing areas.

2. Monitoring: Regular follow-up with your healthcare provider can help monitor the healing process. If there are signs of improper healing or complications, surgical options can be reconsidered.

3. Functional Assessment: It’s essential to assess how the injury affects your daily life. If the toe's function is not significantly impaired and you can manage pain effectively, conservative treatment may be sufficient.

Conclusion
In summary, the decision to proceed with surgery for a fractured fourth toe should be made after careful consideration of the pros and cons, as well as a thorough discussion with your orthopedic surgeon. Factors such as the specific nature of the fracture, your activity level, and personal preferences should all be taken into account. If surgery is deemed necessary, it can provide benefits in terms of alignment and reducing the risk of future complications. However, if the fracture is stable and manageable, conservative treatment may be a suitable path. Always ensure to follow up with your healthcare provider to monitor your healing progress and make informed decisions about your treatment options.

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