What is the treatment for a tuft fracture of the great toe?

Treatment of Tuft Fracture of the Great Toe

For a tuft fracture of the great toe, the recommended treatment is immobilization with a rigid-soled shoe or walking boot for 2-3 weeks, followed by a gradual return to normal footwear and activities as pain allows. 1, 2

Diagnosis Confirmation

• Anteroposterior, lateral, and oblique radiographs should be obtained to confirm the diagnosis and rule out displacement or intra-articular involvement 1
• Point tenderness at the fracture site and pain with gentle axial loading of the digit are typical clinical findings 3

Treatment Algorithm

Non-displaced Tuft Fractures (Most Common)

1. Initial Management:

   • Rigid-soled shoe or walking boot for 2-3 weeks 2
   • Appropriate analgesia: NSAIDs if not contraindicated, with opioids reserved for severe pain 4
   • Weight-bearing as tolerated based on pain level 1

2. Follow-up Care:

   • Transition to regular supportive footwear after 2-3 weeks as pain subsides 2
   • Total healing time: 4-6 weeks 2

Displaced Tuft Fractures

1. Assessment for Referral Criteria:

   • Evaluate for:
     • Circulatory compromise
     • Open fracture
     • Significant soft tissue injury
     • Fracture-dislocation
     • Displacement involving >25% of joint surface 3

2. Management:

   • If displacement criteria for referral are not met: Buddy taping to adjacent toe and rigid-soled shoe for 4-6 weeks 3, 2
   • If referral criteria are met: Orthopedic consultation for possible reduction and stabilization 3

Special Considerations

Complications to Monitor

• Arthritis
• Infection (especially with open fractures)
• Malunion or nonunion
• Compartment syndrome (rare in toe injuries) 1

Follow-up Recommendations

• Clinical assessment at 2-week intervals initially to evaluate:
  • Pain levels
  • Range of motion
  • Fracture healing
  • Functional improvement 4
• Consider longer follow-up (up to 6 months) for patients with persistent symptoms or complications 4

Rehabilitation

• Begin gentle range of motion exercises after 2-3 weeks when pain allows 4
• Progress to strengthening exercises after fracture healing is evident (typically 4-6 weeks) 4
• Goal: Return to pre-injury function and mobility 4

Unlike fractures in other parts of the foot that may require more complex management (such as Jones fractures or Lisfranc injuries), tuft fractures of the great toe generally have a good prognosis with appropriate conservative management and rarely require surgical intervention 1, 2.