What is the treatment for a toe fracture?

Treatment of Toe Fractures

The treatment for toe fractures primarily involves buddy taping and a rigid-sole shoe to limit joint movement, with most toe fractures healing well with conservative management over 2-6 weeks. 1, 2

Initial Assessment

• Check for signs of fracture:

  • Point tenderness at the fracture site
  • Pain with gentle axial loading of the digit
  • Swelling and bruising
  • Difficulty bearing weight

• Obtain appropriate imaging:

  • Anteroposterior and oblique radiographs to identify fractures, determine displacement, and evaluate adjacent phalanges 1
  • Weight-bearing views when possible 2

Treatment Algorithm

For Stable, Nondisplaced Toe Fractures (Most Common)

1. Buddy taping (taping the injured toe to an adjacent uninjured toe)
2. Rigid-sole shoe or hard-soled shoe for 2-6 weeks
3. Weight-bearing as tolerated based on pain level
4. Pain management with over-the-counter analgesics

For Displaced Fractures of Lesser Toes

1. Manual reduction to restore alignment
2. Buddy taping after reduction
3. Hard-soled shoe for 2-6 weeks
4. Follow-up to ensure maintenance of reduction

For Great Toe Fractures

• Require special attention due to their role in weight-bearing 2
• May require longer immobilization (3-6 weeks)
• Hard-soled shoe or walking boot

When to Refer to Orthopedics/Podiatry

Immediate referral is indicated for:

• Circulatory compromise
• Open fractures
• Significant soft tissue injury
• Fracture-dislocations
• Displaced intra-articular fractures
• Fractures of the first toe (great toe) that are:
  • Unstable
  • Involve more than 25% of the joint surface
  • Significantly displaced 1

Special Considerations

Pediatric Toe Fractures

• Most children with fractures of the growth plate (physis) should be referred
• Seymour fractures (open physeal fractures of the distal phalanx) require special attention as they can lead to infection, pain, nail deformity, and growth arrest if missed 3

Great Toe Sesamoid Fractures

• May require more aggressive treatment as they often fail to heal with conservative management 4
• May eventually require surgical excision if persistent symptoms

Follow-up Recommendations

Most uncomplicated toe fractures do not require routine fracture clinic follow-up, as they heal well with conservative management 5. A study found that only 2 of 65 patients with toe fractures required surgery, with no patients developing symptomatic malunion or requiring subsequent surgery during a 2-year follow-up period 5.

Common Pitfalls to Avoid

1. Missing open fractures or Seymour fractures in children, which require surgical intervention
2. Overlooking great toe fractures, which need more careful management due to their weight-bearing function
3. Unnecessary referrals to fracture clinics for stable, nondisplaced toe fractures that can be managed effectively with conservative treatment
4. Inadequate immobilization leading to prolonged pain or malunion
5. Failing to provide adequate pain management during the initial healing phase

Following these guidelines will lead to optimal outcomes for most patients with toe fractures while minimizing unnecessary healthcare utilization.