From the Guidelines
Treatment for a probable incomplete fracture of the proximal phalanx of the fifth toe typically involves simple immobilization, as surgery is usually reserved for more complex cases with significant displacement or articular involvement 1. When managing this type of injury, it's essential to consider the principles of fracture care, which prioritize stability, alignment, and prompt healing to minimize morbidity and optimize quality of life. Key aspects of conservative management include:
- Immobilization: Using techniques such as "buddy taping" to secure the injured toe to an adjacent toe, thereby reducing movement and promoting healing.
- Pain management: Utilizing over-the-counter analgesics like acetaminophen or ibuprofen to control pain, as these are effective for managing the discomfort associated with minor fractures.
- Reduction of swelling: Applying ice and elevating the foot to minimize swelling and promote comfort.
- Gradual return to activity: Allowing weight-bearing as tolerated and gradually increasing activity levels as pain subsides, which helps in maintaining mobility and reducing the risk of long-term disability. It's crucial to monitor the patient's progress and seek medical attention if there are signs of complications, such as increased pain, numbness, or color changes, as these could indicate a need for more intensive intervention 1.
From the Research
Treatment Options for Probable Incomplete Fracture of the Proximal Phalanx of the Fifth Toe
- The treatment for a probable incomplete fracture of the proximal phalanx of the fifth toe can be managed conservatively with buddy taping and immediate mobilisation 2.
- This approach allows for functional recovery and has been shown to have high overall satisfaction, with minimal complications such as malrotation and lack of extension 2.
- Another study suggests that extra-articular proximal phalanx base fractures can be treated non-operatively, with excellent or good outcomes attained in 80% of cases 3.
- Operative management, including Kirschner wires (K-wires), plates, and intramedullary screws, can also be considered, but the current evidence is limited for plate or intramedullary screw fixation 3.
- For lesser toe fractures, buddy taping and a rigid-sole shoe for four to six weeks can be an effective treatment option 4.
Considerations for Treatment
- The location of the fracture and its effect on balance and weight bearing should be taken into account when determining the treatment plan 4.
- The degree of displacement and stability of the fracture reduction should also be considered when deciding between conservative and operative management 2.
- The patient's overall health and activity level should be considered when selecting a treatment option, as some treatments may require prolonged immobilization or weight-bearing restrictions 4.