What is the follow-up care for a 5th proximal toe (phalangeal) fracture?

From the Guidelines

Follow-up care for a 5th proximal toe fracture should include buddy taping, immobilization, and possible X-rays at 2-3 weeks to confirm proper bone alignment, as simple immobilization is often sufficient for small, nonarticular, or minimally displaced fractures 1. When managing a 5th proximal toe fracture, it's essential to prioritize immobilization and stability to promote proper healing.

• Buddy taping the injured toe to the adjacent 4th toe for 3-4 weeks is a common approach, providing stability while allowing the fracture to heal.
• Patients should elevate the foot when possible and apply ice for 15-20 minutes several times daily during the first 48-72 hours to reduce swelling.
• Weight-bearing is usually allowed as tolerated with a stiff-soled, supportive shoe or walking boot.
• Pain management typically consists of acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 5-7 days.
• Follow-up appointments should occur at 2-3 weeks to assess healing, with possible X-rays to confirm proper bone alignment, as recommended by the american college of foot and ankle surgeons 1. Key considerations in the follow-up care include monitoring for signs of complications, such as infection or improper healing, and adjusting the treatment plan as needed to ensure optimal outcomes.
• Most patients can gradually return to normal activities after 4-6 weeks, though complete healing may take 6-8 weeks.
• Physical therapy is rarely needed but may be beneficial if stiffness persists.

From the Research

Follow-up Care for 5th Proximal Toe Fracture

• The follow-up care for a 5th proximal toe (phalangeal) fracture typically involves monitoring the healing process and managing any potential complications 2, 3.
• According to the study by 3, lesser toe fractures, including those of the 5th proximal toe, can be treated with buddy taping and a rigid-sole shoe for four to six weeks.
• The study by 2 suggests that anteroposterior and oblique radiographs are generally most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits.
• However, the study by 4 found that most toe phalangeal fractures can be successfully treated nonoperatively without any residual deformity and are usually clinically asymptomatic, suggesting that follow-up in a fracture clinic may not be necessary for undisplaced and stable fractures.

Radiographic Evaluation

• Radiographic evaluation, including X-rays, is an essential part of diagnosing and managing toe fractures 2, 3.
• The study by 3 mentions that radiographic evaluation is necessary to determine the location and severity of the fracture, as well as to monitor the healing process.
• However, the study by 4 suggests that routine follow-up X-rays may not be necessary for all patients with toe fractures, especially those with undisplaced and stable fractures.

Treatment and Management

• The treatment and management of 5th proximal toe fractures depend on the severity and location of the fracture, as well as the patient's overall health and activity level 3, 5.
• The study by 6 found that patients with avulsion fractures of the fifth metatarsal base can be treated with a hard-soled shoe and allowed to bear weight as tolerated, with most patients returning to pre-injury functional status within 6 months.
• The study by 5 suggests that operative treatment of toe fractures is only rarely necessary, and that most patients can be treated conservatively with good success.