Diagnosis
The diagnosis is often only made clinically. This means that the questioning of the cause of the injury and the symptoms as well as the physical examination are sufficient to make a diagnosis of capsule rupture. If the pain is unusually severe, the healing time is particularly long or instabilities can be found in the physical examination, further diagnostics can be performed to determine concomitant injuries.
With the help of an X-ray image, especially bone involvement can be identified and determined. An MRI can also be consulted to examine the extent of the capsule tear more closely. MRI examinations are rarely used in everyday clinical practice in cases of capsule rupture.
Since the MRI examination does not usually result in a change in treatment, even if the diagnosis is confirmed, it is usually not performed. In addition, the MRI examination is a very expensive and, compared to X-ray examination, a complex procedure. In principle, however, a capsule tear in the toe can be visualized very well in magnetic resonance imaging. Soft tissue in particular can be detected with high resolution, including ligaments, muscles and joint effusions. In addition, MRI does not involve any radiation exposure as is the case with X-rays or CT examinations.
Treatment
The most important treatment steps must be taken immediately after the injury. The treatment for injuries of this type is based on the so-called “PECH scheme”. The initial letters contain the words “pause”, “ice, “compression” and “elevation”.
These immediate measures can, above all, stop acute bruising and thus reduce swelling, pain and restriction of movement, thus significantly reducing the healing time. These 4 treatment measures should be carried out within the first 48 hours. Afterwards, adequate pain therapy and protection as well as immobilization of the toe should be carried out.
Particularly pronounced bruises can be punctured and relieved under certain circumstances. Surgery is rarely necessary, often only if a bone is broken in addition to the capsule tear. Only after a certain time, when the swelling and pain have subsided, should a slight movement in the joint be resumed in order to restore function slowly and carefully.
If a fracture of the toe is ruled out, the treatment should focus on immobilising the toe. The so-called “buddy taping” is recommended for this. Here, a neighboring toe is used as a splint for the injured toe and glued to it.
With a rigid tape bandage around both toes, the toe with the torn capsule can be immobilized and protected. It is important that the tape is changed regularly and after showering. Care should also be taken to ensure that the skin under the tape bandage is healthy and that the toe is additionally relieved by appropriate footwear.
Comfortable but also protective and stable closed shoes are suitable for this. A splint can also be used to immobilize the injured toe. This can be particularly useful for the big toe, which is difficult to immobilize completely with shoes and tapes.
A splint is often not necessary for the other toes. A bandage or tape can usually provide adequate immobilization and protection. A bandage can be used as an alternative to a splint or tape to protect the capsule tear in the toe and immobilize the injured area.
A bandage is elastic and covers the entire foot and heel. Similar to a splint, the bandage is particularly suitable for injuries to the big toe, as this protrudes prominently, is difficult to tape to other toes and is subject to increased stress when walking. In contrast to the splint, the bandage takes up less space in the shoe and is more comfortable to wear, but cannot achieve complete immobilization due to its elastic material.
This makes the bandage unsuitable in the acute phase and the first days to weeks after the injury. It can provide additional support during the following weeks of healing, but can also promote the slow build-up of movement. Surgery on the toe is only very rarely necessary.
A pure capsule rupture of the toe is usually only treated conservatively by gentle and slow movement. In some cases, however, a bone fracture may be present in addition to the capsule tear.Slight bone splinters are also treated conservatively, whereas a complete fracture of the toe may require surgery. Surgery is necessary if there is a malpositioning of the toe or instability in the foot while walking. Also an open fracture with injuries up to the skin surface often requires surgery. The fracture is brought back into its natural position during the operation and stabilized with screws.