CLINICAL CASE PRESENTATION
1. Patient Profile
Age/Gender: 51-year-old female
Weight: 101 kg
Date of Consultation: September 4, 2026
2. Presenting Complaints
The patient presented with:
A 7-week-old closed fracture of the proximal phalanx of the right 4th toe.
Lower back discomfort with neuropathic symptoms for approximately 6 months, associated with multilevel lumbar and foraminal spinal stenosis.
3. History of Present Illness
The patient was being evaluated for a right 4th toe fracture sustained approximately 7 weeks earlier. She continued to have mild swelling and tenderness over the affected toe.
She also reported a 6-month history of lower back symptoms with associated neuropathic complaints. The spinal condition was documented as multilevel lumbar spinal stenosis with foraminal narrowing involving L3–L4, L4–L5, and L5–S1.
4. General Examination
Blood Pressure: 110/70 mmHg
Pulse Rate: 96 beats/min
Temperature: 98.4°F
SpO₂: 95% on room air
Weight: 101 kg
5. Local Examination
Examination of the right foot showed:
Mild swelling over the right 4th toe
Local tenderness on palpation
6. Investigations
X-ray – Right Foot
X-ray examination demonstrated good callus formation at the fracture site of the proximal phalanx of the right 4th toe, suggesting satisfactory progression of fracture healing.
Laboratory Investigations Advised
A bone profile was advised, including:
Serum calcium
Serum phosphorus
Serum magnesium
Serum vitamin D₃
Serum potassium
7. Clinical Diagnosis
Healing closed fracture of the proximal phalanx of the right 4th toe, approximately 7 weeks old.
Multilevel lumbar spinal stenosis with foraminal stenosis at L3–L4, L4–L5, and L5–S1, associated with neuropathic symptoms.
High body weight/obesity.
8. Management
Orthopedic Management
Toe support splint advised for 3 weeks to protect the healing fracture.
Medications
Pregabalin + Methylcobalamin: 1 tablet at bedtime for 30 days.
Chymoral Forte (Trypsin + Chymotrypsin): 1 tablet three times daily for 10 days.
Uprise D3 (Cholecalciferol/Vitamin D₃ 60,000 IU): 1 tablet weekly for 8 weeks, followed by once monthly for 3 months.
Gemcal Plus (Calcium + Vitamin D₃): 1 tablet daily for 30 days.
Maxuron Plus: 1 tablet daily for 30 days.
Magnesium Glycinate: 1 tablet daily for 30 days.
Supportive Measures
Use of a donut cushion to reduce pressure while sitting.
Regular physical activity was encouraged within the patient's functional limits.
9. Follow-Up
Follow-up was advised in approximately 6 weeks to 3 months for reassessment of fracture healing and evaluation of the lumbar spine-related symptoms.
References
American Academy of Orthopaedic Surgeons (AAOS). Toe and Forefoot Fractures. OrthoInfo.
Munakomi S, Foris LA, Varacallo MA. Spinal Stenosis and Neurogenic Claudication. StatPearls. NCBI Bookshelf.
National Institutes of Health, Office of Dietary Supplements. Vitamin D – Fact Sheet for Consumers. NIH.
Mayo Clinic. Broken Toe: Diagnosis and Treatment. 2026.
Medical Disclaimer: The information provided in this article is strictly for educational, study, and exam-preparation purposes. It does not constitute professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for clinical decisions.