From the Guidelines
The recommended treatment for a proximal phalanx great toe fracture typically involves conservative management for non-displaced or minimally displaced fractures, with simple immobilization being appropriate when fracture fragments are small, nonarticular, or minimally displaced, as stated by the American College of Foot and Ankle Surgeons 1. When it comes to post-operative shoeing, the goal is to limit motion at the fracture site and promote healing.
- The use of a rigid-soled shoe or walking boot is recommended for 3-4 weeks to allow for proper healing and alignment.
- Weight-bearing is usually allowed as tolerated, and pain management can be achieved with acetaminophen or NSAIDs like ibuprofen for 5-7 days.
- For displaced fractures, closed reduction followed by buddy taping to the adjacent toe for 3-4 weeks is recommended, while severely displaced or unstable fractures may require surgical fixation. Key considerations for treatment include:
- The size and displacement of the fracture fragments
- The presence of any articular involvement
- The overall stability of the fracture
- The patient's ability to tolerate weight-bearing and mobility Given the excellent blood supply and surrounding soft tissues of the great toe's proximal phalanx, conservative management is often effective, with most fractures healing within 4-6 weeks, as supported by the American College of Foot and Ankle Surgeons 1.
From the Research
Treatment for Proximal Phalanx Great Toe Fracture
The recommended treatment for a proximal phalanx great toe fracture can vary depending on the severity and type of fracture.
- For acute fractures, primary conservative management (PCM) is often used, with return to sport rates (RRS) ranging from 0 to 100% and return times (RTS) ranging from 1.2 to 24 weeks 2.
- For displaced intra-articular fractures, primary surgical management (PSM) is indicated, with RRS of 100% and RTS ranging from 12 to 24 weeks 2.
- For stress fractures, conservative management is also commonly used, with RRS ranging from 0% to 100% and RTS ranging from 5 to 10 weeks 2.
- In cases of delayed diagnosis or non-union, surgical management may be necessary, with satisfactory RRS and RTS 2, 3.
Post-Operative Care
For post-operative care, the use of a post-op shoe may be recommended to protect the toe and promote healing.
- However, the exact duration of post-op shoe use is not specified in the available studies.
- A study on non-union of proximal phalanx fracture treated with L-facial plate and screw and bone grafting reported that the patient was able to bear full weight and walk normally without pain after surgery 4.
- Another study reported that athletes with stress fractures of the proximal phalanx can return to sports activities after approximately 10 weeks of conservative management or surgical treatment 3.