What is the treatment for a toe fracture?

Treatment of Toe Fractures

For toe fractures, treatment consists primarily of buddy taping and a rigid-sole shoe for 4-6 weeks, allowing early mobilization and weight-bearing as tolerated. 1, 2, 3, 4

Diagnosis

Before initiating treatment, proper diagnosis is essential:

• Use the Ottawa rules to determine if imaging is necessary:

  • Check for point bone tenderness at the base of the fifth metatarsal
  • Assess ability to bear weight or walk 4 steps immediately after injury 1, 5
  • Evaluate for palpation pain at the metatarsal bones 5

• Radiographic evaluation:

  • Anteroposterior and oblique views are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges 2
  • Weight-bearing radiographs may be needed for certain fractures to detect dynamic abnormalities 1

Treatment Algorithm

For Lesser Toe Fractures (2nd-5th toes)

1. Stable, non-displaced fractures:

   • Buddy taping to adjacent toe
   • Rigid-sole shoe for 4-6 weeks
   • Early mobilization and weight-bearing as tolerated 2, 4

2. Displaced fractures:

   • Reduction (realignment) of the fracture
   • Buddy taping to adjacent toe
   • Rigid-sole shoe for 4-6 weeks 2

For Great Toe (Hallux) Fractures

1. Non-displaced fractures:

   • Short leg walking boot or cast with toe plate for 2-3 weeks
   • Transition to rigid-sole shoe for additional 3-4 weeks 4

2. Displaced fractures:

   • Often require referral for stabilization of the reduction 2
   • Special attention needed due to the great toe's important role in weight-bearing 3

Pain Management

• Multimodal pain control approach:
  • Acetaminophen and NSAIDs as first-line treatment
  • Topical NSAIDs with or without menthol gel
  • Opioids should be avoided due to their potential risks 1

Indications for Referral

Refer patients with:

• Circulatory compromise
• Open fractures
• Significant soft tissue injury
• Fracture-dislocations
• Displaced intra-articular fractures
• Fractures of the first toe that are unstable or involve more than 25% of the joint surface 2

Rehabilitation and Follow-up

• Early mobilization to prevent stiffness and promote healing
• Avoid prolonged immobilization to prevent deconditioning
• Clinical and radiographic follow-up at 2 weeks and 4-6 weeks to ensure maintained alignment and assess healing 1
• Monitor for complications such as:
  • Delayed union or non-union
  • Post-traumatic arthritis
  • Persistent pain or instability
  • About 20% of patients may experience chronic pain 1

Special Considerations

• Children with fractures of the physis (growth plate) generally should be referred, except for selected non-displaced Salter-Harris types I and II fractures 2
• Elderly patients may benefit from earlier mobilization 1
• Athletes may require more structured rehabilitation protocols 1

Prevention of Future Fractures

• Gradual increase in activity intensity and duration
• Appropriate footwear
• Cross-training to reduce repetitive stress
• Address biomechanical abnormalities with orthoses if needed 1

Most toe fractures have excellent outcomes with appropriate conservative management. The key is to identify those that require specialist referral while providing adequate pain control and early functional rehabilitation for those that can be managed in the primary care setting.