Management of Non-Displaced Toe Fractures
For a non-displaced toe fracture, a boot is not necessary; buddy taping and a hard-soled shoe are sufficient for treatment in most cases.
Assessment and Classification
When evaluating a toe fracture, consider:
- Location: Lesser toes vs. great toe
- Displacement: Displaced vs. non-displaced
- Stability: Stable vs. unstable
- Joint involvement: Intra-articular vs. extra-articular
Treatment Approach for Non-Displaced Toe Fractures
Lesser Toe Fractures (2nd-5th toes)
- Primary treatment: Buddy taping to adjacent toe and rigid-sole shoe 1
- Duration: 2-6 weeks depending on healing and pain resolution 2
- No need for a walking boot for these simple fractures
- Weight-bearing as tolerated is generally acceptable
Great Toe (1st toe) Fractures
- Non-displaced, stable fractures: Hard-soled shoe for 2-6 weeks 2
- Consider a walking boot only if:
- Patient has significant pain with ambulation
- Fracture involves >25% of joint surface
- Fracture shows signs of instability
Rationale for Treatment Selection
The evidence supports using simpler immobilization methods for non-displaced toe fractures rather than more restrictive devices like walking boots:
Effectiveness: Buddy taping with a hard-soled shoe provides adequate stabilization for non-displaced toe fractures 1
Mobility: Excessive immobilization with a boot may lead to:
- Decreased patient mobility
- Muscle atrophy
- Potential for falls due to gait alteration
Patient comfort: Less restrictive options improve compliance and quality of life while still allowing healing
Special Considerations
When to Consider a Boot
- Great toe fractures with significant pain or borderline stability
- Patients with peripheral neuropathy or poor pain perception 3
- Multiple toe fractures or associated foot injuries
- Patients with poor compliance with buddy taping
When to Refer
Orthopedic referral is indicated for:
- Circulatory compromise
- Open fractures
- Significant soft tissue injury
- Fracture-dislocations
- Displaced intra-articular fractures
- First toe fractures that are unstable or involve >25% of joint surface 1
Follow-up Care
- Clinical reassessment at 2-3 weeks
- Transition to regular footwear when pain-free
- Consider radiographic follow-up only if symptoms persist beyond expected healing time
Conclusion
Non-displaced toe fractures can be effectively managed with buddy taping and a rigid-sole shoe. A walking boot represents overtreatment for most simple toe fractures and may unnecessarily limit mobility and function. Reserve boot immobilization for cases with specific indications such as great toe fractures with significant pain or instability.