Buddy Taping for Non-Displaced Toe Fractures
Buddy taping is an effective and appropriate treatment option for non-displaced toe fractures, providing adequate stabilization while allowing for earlier mobility compared to more restrictive immobilization methods.
Treatment Approach for Toe Fractures
Initial Assessment
- Toe fractures typically present with:
- Point tenderness at fracture site
- Pain with gentle axial loading
- Difficulty with weight-bearing
- Radiographic evaluation with anteroposterior and oblique views is essential to:
- Confirm fracture presence
- Determine displacement
- Evaluate adjacent structures 1
Treatment Algorithm for Toe Fractures
Non-Displaced Toe Fractures
For stable, non-displaced toe fractures:
- Buddy taping - Secure the injured toe to an adjacent healthy toe
- Rigid-sole shoe - To limit joint movement and provide protection
- Treatment duration: 4-6 weeks 1, 2
When to Refer
Buddy taping is NOT appropriate and referral is indicated for:
- Circulatory compromise
- Open fractures
- Significant soft tissue injury
- Fracture-dislocations
- Displaced intra-articular fractures
- First toe (great toe) fractures that are:
- Unstable
- Involve >25% of joint surface 1
Proper Buddy Taping Technique
To minimize complications:
- Place gauze or cotton between toes to prevent skin maceration
- Use appropriate width tape (not too tight)
- Monitor for skin irritation or pressure points
- Change tape regularly to maintain cleanliness
- Instruct patient on proper hygiene between toes 3
Specific Considerations by Toe Location
Lesser Toe Fractures (2nd-5th toes)
- First-line treatment: Buddy taping with rigid-sole shoe for 4-6 weeks 2
- If displaced: Reduction followed by buddy taping
Great Toe Fractures
- Require more robust immobilization
- Short leg walking boot or cast with toe plate for 2-3 weeks
- Followed by rigid-sole shoe for additional 3-4 weeks 2
- Buddy taping alone is generally insufficient
Potential Complications of Buddy Taping
Clinicians should be aware of and monitor for:
- Skin necrosis (45% of surgeons reported skin injuries)
- Infections between toes
- Loss of fixation
- Limited joint motion
- Poor patient compliance (65% of surgeons reported this issue) 3
Follow-up Recommendations
- Initial follow-up at 1-2 weeks to assess:
- Skin condition
- Maintenance of reduction
- Patient compliance
- Final follow-up at 4-6 weeks to confirm healing
Special Considerations
- For pseudarthrosis (non-union) after buddy taping, adjunctive treatments like low-intensity pulsed ultrasound (LIPUS) may be beneficial 4
- Patient education regarding proper buddy taping technique and expected recovery timeline is essential for compliance
Buddy taping represents a balanced approach between adequate immobilization and functional recovery for non-displaced toe fractures, allowing earlier mobility while providing sufficient stability for healing.