What to do for a fracture at the base of the 5th toe

Management of Fracture at Base of 5th Toe

For a fracture at the base of the 5th toe, splinting the toe in the position found and using a hard-soled shoe or controlled ankle motion (CAM) walker boot is the recommended treatment approach. 1

Initial Assessment and Treatment

Immediate Management

• Assess for signs of fracture: obvious deformity, swelling, bruising, severe pain with movement 1
• Check for blue, purple, or pale appearance of the toe which may indicate poor perfusion requiring immediate medical attention 1
• Apply splinting to the fractured toe to reduce pain, prevent further injury, and facilitate healing 1

Splinting Technique

• Splint the toe in the position found unless straightening is necessary for safe transport 1
• Buddy-taping (taping the injured toe to an adjacent healthy toe) is an effective method for splinting a 5th toe fracture
• Cover any open wounds with clean dressing to prevent contamination and infection 1

Footwear Options

Primary Options

1. CAM-Walker Boot

   • More effective at offloading the 5th metatarsal during gait activities 2
   • Provides better immobilization and protection
   • Results in faster bone healing (average 7.2 weeks) compared to hard-soled shoes (8.6 weeks) 3

2. Hard-Soled Shoe

   • Alternative option with similar clinical and functional outcomes 3
   • May be more comfortable for some patients
   • Average healing time of 8.6 weeks 3

Special Orthopedic Boot

• An orthopedic boot allows for full weightbearing after approximately 9 days 4
• Has shown high patient satisfaction rates (92%) with no complications 4

Treatment Duration and Follow-up

• Average time to return to prior level of activities: 8-10 weeks 3
• Typical sick leave duration: approximately 19 days 4
• Follow-up radiographs should be considered to confirm healing

Special Considerations

• Non-displaced fractures can be treated conservatively with good success 5
• Long-term relief and immobilization including the ankle joint are unnecessary 5
• For fractures with displacement >3-4mm or angulation >10 degrees, surgical fixation may be indicated 6
• Avoid manipulation of the toe prior to radiographs unless there is neurovascular deficit 1

Pitfalls to Avoid

• Failing to include the base of the fifth metatarsal in radiographic assessment 1
• Overlooking associated injuries that may occur with inversion trauma
• Overtightening compression wraps which can compromise circulation 1
• Neglecting to check for signs of poor perfusion (blue, purple, or pale appearance) which requires immediate medical attention 1

This treatment approach balances the need for proper healing with maintaining function and patient comfort, while minimizing complications and promoting early return to activities.