Management of 5th Toe Fractures
For most 5th toe fractures, buddy taping with a rigid-sole shoe for 2-6 weeks is the recommended management approach, as this provides adequate stabilization while allowing earlier return to normal activities compared to more restrictive immobilization methods. 1, 2
Diagnosis
- Point tenderness at fracture site or pain with gentle axial loading of the digit
- Anteroposterior and oblique radiographs are most useful for:
- Identifying fractures
- Determining displacement
- Evaluating adjacent phalanges and digits
Treatment Algorithm
1. Stable, Nondisplaced Fractures (Most Common)
- Primary Treatment: Buddy taping to adjacent toe + rigid-sole shoe
- Duration: 2-6 weeks depending on healing and pain resolution
- Follow-up: Minimal imaging needed after initial diagnosis
- Weight-bearing: As tolerated based on pain
2. Displaced Fractures of 5th Toe
- Primary Treatment: Reduction followed by buddy taping + rigid-sole shoe
- Technique: Manual reduction with digital pressure
- Immobilization: Same as nondisplaced fractures after reduction
3. Special Considerations
Hard-Soled Shoe vs. CAM-Walker Boot
Recent evidence suggests that using a hard-soled shoe may be preferable to a walking boot for similar fractures (based on fifth metatarsal fracture data) as it:
- Is less restrictive for patients 3
- Results in shorter time to pain-free walking (4.6 vs 8.4 weeks) 3
- Allows earlier return to normal footwear (6 vs 7.3 weeks) 3
- Promotes early range of motion of the ankle 3
Indications for Referral
Refer patients with:
- Circulatory compromise
- Open fractures
- Significant soft tissue injury
- Fracture-dislocations
- Displaced intra-articular fractures
Complications to Monitor
- Delayed union or nonunion (rare in toe fractures)
- Residual pain
- Malunion (usually well-tolerated in lesser toes due to minimal functional impact)
Follow-up Recommendations
- Clinical assessment at 2-4 weeks to ensure proper healing
- Additional imaging only if symptoms persist or worsen
- Consider telehealth follow-up when possible to minimize unnecessary visits 4
Treatment Pearls
- Accept that there may be more initial deformity than previously tolerated; the high remodeling potential in pediatric patients mitigates risk of residual deformity 4
- Minimize post-treatment imaging that will not change management 4
- For persistent nonunion with symptoms, low-intensity pulsed ultrasound (LIPUS) therapy may be considered as a non-surgical intervention 5
By following this approach, most 5th toe fractures can be successfully managed with minimal intervention, allowing patients to return to normal activities quickly while ensuring proper healing.