What is the management for a minimally displaced fracture of the proximal phalanx of the 3rd toe?

Management of Minimally Displaced Fracture of the Proximal Phalanx of the 3rd Toe

The most appropriate management for a minimally displaced fracture of the proximal phalanx of the 3rd toe is conservative treatment with buddy taping and a rigid-sole shoe to limit joint movement.

Initial Assessment and Treatment

• Minimally displaced toe fractures typically present with:

  • Point tenderness at the fracture site
  • Pain with gentle axial loading of the digit
  • Possible swelling and bruising around the fracture site

• Imaging:

  • Anteroposterior and oblique radiographs are most useful for:
    • Confirming the fracture
    • Determining the degree of displacement
    • Evaluating adjacent phalanges and digits 1

Conservative Management Protocol

1. Primary Treatment: Buddy Taping

   • Tape the injured toe to an adjacent uninjured toe (usually the 4th toe)
   • Use gauze between the toes to prevent skin maceration
   • Change the tape every 1-2 weeks or when soiled

2. Footwear Modification

   • Recommend a rigid-sole shoe or post-operative shoe
   • This limits movement at the fracture site and provides protection
   • Continue for 3-4 weeks or until pain-free with ambulation

3. Weight-bearing Status

   • Weight-bearing as tolerated is acceptable
   • No specific restrictions needed for minimally displaced fractures of the lesser toes

4. Pain Management

   • Over-the-counter analgesics as needed (acetaminophen or NSAIDs if not contraindicated)
   • Ice application for the first 48-72 hours to reduce swelling

Expected Healing Timeline

• Bone healing typically occurs within 4-6 weeks
• Full resolution of symptoms may take 6-8 weeks
• Most patients can return to normal activities by 6 weeks

When to Consider Referral

Referral to a specialist is indicated in cases with:

• Circulatory compromise
• Open fractures
• Significant soft tissue injury
• Fracture-dislocations
• Displaced intra-articular fractures
• Fractures of the first toe (hallux) that are unstable or involve >25% of the joint surface 1

Follow-up Recommendations

• Clinical follow-up in 2-3 weeks to ensure proper healing
• Repeat radiographs are generally not necessary for minimally displaced fractures of lesser toes
• Studies have shown that routine fracture clinic follow-up for toe fractures may be unnecessary in most cases 2

Potential Complications

• Malunion (usually well-tolerated in lesser toes)
• Persistent pain or stiffness
• Delayed union or nonunion (rare in toe fractures)

Important Considerations

• The high rate of non-attendance at fracture clinics for toe fractures (19% in one study) suggests that many patients self-manage successfully 2
• Only a small percentage of toe fractures require surgical intervention, with most healing well with conservative management 2
• Unlike fractures of the hallux or fingers, lesser toe fractures rarely require surgical intervention even when minimally displaced 3

The evidence strongly supports that stable, minimally displaced fractures of the lesser toes can be effectively managed with simple buddy taping and appropriate footwear, with excellent functional outcomes and minimal risk of complications.