Knife Vs. Toe: Take A Stab At This Diagnosis

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Knife Vs. Toe: Take A Stab At This Diagnosis - Page #1

Author: Christopher Case, MD Co Author #1: Rodolfo Navarro, MD Co Author #2: Jeremy Dickerson, MD Senior Editor: Warren Bodine, DO, FAMSSM Editor: Rathna Nuti, MD Patient Presentation: 26-year-old female presents to clinic following an injury to her left great toe that was sustained 6 days prior. History: She reports that she dropped a knife from around waist high. The knife fell point-first directly on the dorsum of her foot near the first MTP joint causing a small laceration. Bleeding was easily controlled. Patient was seen in the ED following injury where it was treated as a superficial laceration. The patient was given a course of clindamycin, tetanus booster was updated, and given a follow-up appointment. At her first visit in our sports medicine clinic, she reported continued 4/10 sharp pain with manipulation and difficulty with flexion and extension of her great toe. She reported minimal discomfort when not moving her toe. Has taken ibuprofen 400mg as needed with minimal change in pain noted. She has not noted any worsening swelling, erythema, or drainage from the wound. Physical Exam: MSK: 5mm well-healed incision over distal left 1st metatarsal, no surrounding erythema or drainage. TTP to dorsal foot directly under incision. Tendon palpable proximal and distal to incision site. Full passive range of motion of great toe with pain over incision area with manipulation. Left great toe in mild plantarflexion at rest compared to right. Patient actively able to flex 1st MTP joint with pain but feels unable to actively extend. No frank instability noted to MTP or IP joint. Otherwise unremarkable foot and ankle exam. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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