#814 What is a phalanx avulsion fracture in the big toe joint? - DOC

#814 What is a phalanx avulsion fracture in the big toe joint?

What is a phalanx avulsion fracture in the big toe joint? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



If you get a fracture in the big toe, it can be a problem because it’s a really important joint and if you do get a fracture in the big toe joint, you might wind up developing a condition called hallux rigidus or hallux limitus, which means the joint gets really stiff and it doesn’t move very well.

Well, there’s lots of different kinds of fractures and injuries to the big toe joint that can happen. You can get sesamoiditis or you can get turf toe or you can actually get an avulsion fracture. And so I was doing a consultation with somebody recently that had one of these and so I wanted to show you what it really is and so that you can understand it better and what it might actually mean in terms of your returning to running.

There are a couple of things is that if you get an avulsion fracture, first of all, all avulsion fracture means is that fracture means it broke and the bone, the Phalanx bone, you have two of them in your big toe. You have the proximal phalanx  and the distal phalanx and usually it’s the proximal phalanx if you’re going to get one.

Basically what it is, is you have these two bones here, and avulse means to rip off. So, if you actually grabbed your arm with a metal claw and pulled the skin off, well that’s an avulsion laceration or avulsion injury to the skin. The ligaments and the joint capsule attached to the base of the toe, if you bend it suddenly, with a tremendous amount of force, the joint capsule or one of the collateral ligaments around that joint might actually stay intact but yank the piece of bone off.

The most common place for an avulsion fracture in the foot is actually the base of the fifth metatarsal. It’s attached to the outside of your foot and when you roll your ankle, sometimes the peroneus brevis tendon that attaches there will pull so hard that it actually cracks the bone. Super common in runners, but it can happen on the big toe joint.

In this case, I’m going show you some images of somebody that had one of these and what happened in her case where she did have one of these and she has a piece of bone that you can see it on her images where there’s a piece of bone sitting under the big toe joint. But when I looked at it from the side, my big question is, does it look like it’s moving? Does it look like it’s rubbing and does look like she’s stepping on it? And so, when I look at that, I’m looking basically at the bottom of the joint trying to see where it’s sitting between the sesamoid bones and the bone here. And if it’s not sitting in a way that looks like the ground is actually going to push it up against the bones above it, it might not actually be causing any pain.

Just because we find one on an X-ray or an MRI or a CT scan, does not mean you need surgery to take it out. You need surgery to take it out if it’s causing pain, or it’s getting inflamed and rubbing on the joint and going to cause damage later. So, how can you tell that?

Well, number one, you can look at it with an ultrasound. We could actually look at an ultrasound, we can move your foot around and see if it’s rubbing against anything. We could also look on an MRI. So, a CT scan might show you more detail of that little piece of bone but in MRI, if you get an MRI and that little fragment of bone looks inflamed on the MRI and the neighboring bone where it’s rubbing looks inflamed, well then maybe you should take it out.

But they’re not always pathologic and that is the point of this story is that not everything that looks wrong needs surgery, particularly if you’re a runner because once you have surgery, your recovery is going to really, really decimate your running fitness and then you have a lot more work to do to actually get back to running as quickly as possible.

If you enjoyed this episode, please like it, please subscribe and if you have one of these kinds of injuries and you’ve been off your foot and you’re trying to get back to running, you want to fast track that process and you want to try to stay fit while it actually heals, check out the fast track that are put together for you.

It’s a series of three days where I walk you through the process of what I would do to tell you how to figure out whether or not you can run right now and what you should be doing to get back to running as quickly as possible and you can actually get it for free if you go to https://www.docontherun.com/fasttrack/.  So, go check it out and I’ll see you in the training.