From the Research
I strongly recommend continuing the current management plan for this 43-year-old male with a left fifth toe fracture, with close monitoring of the numbness in the toe, as the reduced inflammation, bruising, and good capillary refill are positive signs of healing. The patient should continue taking acetaminophen and naproxen as prescribed for pain management. The lack of sensation in the toe is concerning and warrants close monitoring, though the positive signs of healing are reassuring. The in-house meals for 30 days will support recovery by ensuring proper nutrition without the need for the patient to prepare food while mobility is limited. Extending the work excuse for two more weeks is appropriate to allow adequate healing time and prevent re-injury from occupational activities.
Key Considerations
- The numbness in the toe could indicate nerve compression from initial swelling or potential nerve damage from the fracture itself, as discussed in 1.
- If sensation does not return within the next 1-2 weeks, further neurological evaluation may be necessary, including electrodiagnostic studies such as nerve conduction and electromyography, as outlined in 2 and 3.
- The patient should be instructed to elevate the foot when possible, apply ice if swelling recurs, and return immediately if pain worsens, swelling increases, or if he develops signs of infection such as increased warmth, redness, or drainage.
Management Plan
- Continue acetaminophen and naproxen for pain management
- Monitor numbness in the toe and adjust management plan as needed
- In-house meals for 30 days to support recovery
- Extend work excuse for two more weeks to allow adequate healing time
- Educate patient on signs of infection and when to return for immediate evaluation
Further Evaluation
- If sensation does not return within 1-2 weeks, consider further neurological evaluation, including electrodiagnostic studies, as discussed in 4.