An “empty” toe

Abstract We report the case of a closed degloving injury of the forefoot in a 33-year-old female motorcyclist. The injury was associated with vascular compromise of the lesser toes. Radiographic examination revealed the little toe soft tissue shadow to be empty of bones (the “empty toe sign”). Despite prompt open reduction of the toe bones into their soft tissue envelope, and measures to encourage distal perfusion, necrosis of the entire little and part of the second and third toes occurred. This is a rare and significant injury with a poor prognosis that despite the absence of skin wounds should not be underestimated.