From the Guidelines
Big toe distal phalanx fracture management should prioritize conservative treatment with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as noted in a study published in the American Family Physician 1. The diagnosis of a distal phalanx fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Key aspects of conservative management include:
- Rest, ice, compression, and elevation (RICE protocol) to reduce pain and swelling
- Wearing stiff-soled, comfortable shoes or a walking boot to immobilize the toe and protect it from further injury
- Weight-bearing as tolerated with appropriate footwear
- Pain management with acetaminophen or NSAIDs like ibuprofen for 5-7 days
- Buddy taping the injured toe to an adjacent toe for additional stability, continued for 3-4 weeks
Surgical intervention is rarely needed but may be considered for open fractures, severely displaced fractures, or those involving more than 25% of the joint surface, as noted in general medical practice. Follow-up radiographs at 3-4 weeks are recommended to ensure proper healing, allowing for timely identification of any complications that may require a change in management strategy.
From the Research
Big Toe Distal Phalanx Fracture Management
- The management of big toe distal phalanx fractures can vary depending on the severity and displacement of the fracture 2, 3.
- For stable, nondisplaced fractures, treatment with buddy taping and a rigid-sole shoe to limit joint movement may be sufficient 2, 3.
- However, displaced fractures of the first toe often require referral for stabilization of the reduction 2.
- In some cases, open reduction and interfragmentary screw fixation may be necessary for symptomatic nonunion of distal phalangeal fractures 4.
- The type of fixation method can range from percutaneous pinning to open reduction and internal fixation, and the choice of treatment should be based on the individual patient's goals and range of motion 5.
Treatment Options
- Buddy taping and rigid-sole shoe for stable, nondisplaced fractures 2, 3
- Reduction and buddy taping for displaced fractures of the lesser toes 2
- Referral for stabilization of the reduction for displaced fractures of the first toe 2
- Open reduction and interfragmentary screw fixation for symptomatic nonunion of distal phalangeal fractures 4
- Percutaneous pinning or open reduction and internal fixation for unstable fracture patterns and those involving the articular surface 5
Complications and Considerations
- Failure to appropriately treat phalangeal fractures can result in finger stiffness, loss in range of motion, and functional deficits 5.
- Acute tendon and bony injuries of the distal phalanx can result in chronic pain, hypersensitivity, stiffness, and deformity if not adequately treated 6.
- Meticulous technique is required to achieve good postoperative outcomes in surgical treatment of distal phalanx injuries 6.