What is the best way to treat a fracture of the 5th toe from stubbing it?

Treatment of 5th Toe Fracture from Stubbing

The best treatment for a fracture of the 5th toe from stubbing is buddy taping to an adjacent toe and wearing a rigid-sole shoe for 4-6 weeks. 1

Initial Assessment and Diagnosis

• Look for point tenderness at the fracture site or pain with gentle axial loading of the digit 2
• Obtain anteroposterior and oblique radiographs to:
  • Identify the fracture
  • Determine displacement
  • Evaluate adjacent phalanges 2

Treatment Algorithm

For Stable, Nondisplaced 5th Toe Fractures (Most Common)

1. Primary Treatment:

   • Buddy tape the injured toe to the adjacent 4th toe 2, 1
   • Provide a rigid-sole shoe to limit joint movement 1
   • Duration: 4-6 weeks 1

2. Pain Management:

   • Over-the-counter pain medications (acetaminophen or NSAIDs) 3
   • Cold application using ice-water mixture with a thin towel barrier
   • Limit ice application to 20 minutes (or 10 minutes if uncomfortable) 4

3. Activity Modification:

   • Restrict activities for 4-6 weeks 3
   • Encourage movement of uninvolved joints to prevent stiffness 3

For Displaced Fractures of the 5th Toe

1. Perform gentle reduction of the displaced fracture 2
2. Buddy tape to the adjacent toe after reduction 2
3. Provide a rigid-sole shoe for 4-6 weeks 1

When to Refer

Immediate referral is necessary for:

• Circulatory compromise (toe appears blue, purple, or pale) 4, 3
• Open fractures 2
• Significant soft tissue injury 2
• Fracture-dislocations 2
• Displaced intra-articular fractures 2

Follow-up and Recovery

• Most patients can expect full recovery in 4-6 weeks 1
• No need for prolonged immobilization that includes the ankle joint 5
• Follow-up radiographs may be needed to ensure proper healing 3

Common Pitfalls to Avoid

1. Overtreating minor fractures: Most 5th toe fractures are stable and don't require casting or surgical intervention 5

2. Inadequate immobilization: Failure to use buddy taping and a rigid-sole shoe can lead to prolonged pain and healing time 1

3. Ignoring displacement: While most 5th toe fractures are nondisplaced, those with significant displacement (>3-4mm) or angulation (>10 degrees) may require more aggressive management 6

4. Prolonged immobilization: Long-term relief and immobilization including the ankle joint are unnecessary and may lead to stiffness 5

5. Missing associated injuries: Always check for injuries to adjacent toes or metatarsals 2

Unlike fractures of the 1st toe or metatarsals, which often require more aggressive treatment, 5th toe fractures typically respond well to conservative management with buddy taping and a rigid-sole shoe 1.