› ! Metatarsal fracture → › ! Toe fracture → Approach to the critical patient first 5 minutes
› Immediate stabilization priorities
› Airway and breathing concerns if toxic
› Cardiac monitoring with sepsis physiology
› IV access criteria
› Two large bore IV with shock concern
› Analgesia early
› Acetaminophen PO 1000 mg once
› Ibuprofen PO 400 mg once
› Avoid NSAID with kidney disease concern
› Limb threat pathway
› If pulseless or mottled foot immediate vascular surgery
› If compartment syndrome concern immediate orthopedics
› Trauma pathway
› Radiographs foot 3 view
› Weight bearing radiographs with Lisfranc concern
› CT with complex fracture concern
› Infection pathway
› CBC
› CRP
› ESR
› Blood cultures with fever
› MRI with osteomyelitis concern
› Inflammatory arthritis pathway
› Arthrocentesis with effusion and severe pain
› Crystal analysis
› Culture regardless of crystals if infection concern
› Immobilization and protection
› Walking boot for suspected fracture pending imaging
› Non weight bearing with Lisfranc concern
› Antibiotics for suspected severe infection
› Local protocol dependent empiric coverage
› MRSA risk based coverage decision
› Gout flare treatment options
› Naproxen PO 500 mg once
› Then naproxen PO 250 mg twice daily
› Colchicine PO 1.2 mg once
› Then colchicine PO 0.6 mg once 1 hour later
› Avoid colchicine with severe kidney disease
› Plantar fasciitis symptom control
› Relative rest
› Ice after activity
› Supportive footwear
› Time based reassessment
› Recheck pain and neurovascular status within 30 to 60 minutes after interventions
› Repeat compartment exam if worsening pain
› Escalation triggers
› Increasing pain despite analgesia
› New numbness
› Worsening perfusion signs
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