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Most dislocations of the forefoot involve the distal interphalangeal and posterior interphalangeal joints of the second through fifth toes. These injuries can be easily reduced by manual traction and treated with buddy taping, as needed. Dislocations of the big toe are rare, occasionally difficult to reduce, and require walking-cast immobilization for 3 weeks.
OPEN FRACTURES
Open fractures of the foot require immediate orthopedic consultation. In the interim, protect open fractures from further contamination by applying a wet, sterile dressing over the wound with a gauze roll. Splint the injury until definitive treatment is available. Consider tetanus immunoglobulin if the wound is grossly contaminated. The antibiotic of choice is cephalexin and add an aminoglycoside if the wound is grossly contaminated. Consider clindamycin for patients with a penicillin allergy. If there is going to be a significant delay to operative management, the wound should be irrigated.
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