What is the proper technique for buddy taping a fractured big toe?

Buddy Taping Technique for Big Toe Fractures

The proper technique for buddy taping a fractured big toe involves securing the injured toe to the adjacent second toe using tape with padding between the toes to prevent skin irritation, followed by wearing a rigid-sole shoe for 2-6 weeks to limit movement and promote healing. 1, 2

Assessment Before Buddy Taping

Before buddy taping, ensure proper assessment of the fracture:

• Confirm diagnosis with anteroposterior and oblique radiographs to determine displacement and evaluate adjacent structures 1
• Assess for signs that would require referral rather than buddy taping:
  • Circulatory compromise or blue/purple/pale appearance of the toe (requires immediate emergency response) 3, 1
  • Open fractures or significant soft tissue injury 1
  • Fracture-dislocations or displaced intra-articular fractures 1
  • Fractures involving more than 25% of the joint surface 1
  • Unstable fractures of the first toe 1

Buddy Taping Technique

1. Preparation:

   • Clean and dry both the injured toe and the adjacent second toe 3
   • Check for any open wounds - if present, cover with a clean dressing before taping to prevent contamination and infection 3

2. Apply padding:

   • Place cotton gauze, foam padding, or felt between the toes to prevent skin maceration and irritation 2
   • Ensure the padding extends the full length of the toes 2

3. Taping method:

   • Use non-elastic adhesive tape (such as cloth athletic tape) approximately 1/2 inch wide 2
   • Wrap the tape around both the fractured big toe and the second toe in a figure-of-eight pattern 1
   • Apply the tape firmly enough to provide stability but not so tight as to compromise circulation 3
   • Place 2-3 strips of tape along the length of the toes for adequate support 2

4. Assess circulation:

   • After taping, check capillary refill of the toes to ensure adequate circulation 3
   • The patient should be able to wiggle the toes slightly 2

Post-Taping Management

• Footwear: Have the patient wear a rigid-sole shoe or walking boot to limit joint movement and provide additional protection 1, 2
• Duration: Maintain buddy taping for 2-6 weeks depending on fracture severity and healing progress 2
• Tape changes: Replace the tape every 1-2 days or when it becomes wet or soiled 2
• Monitor for complications: Check for skin irritation, pressure sores, or signs of infection 1

Special Considerations

• Great toe fractures require special attention due to their important role in weight-bearing and balance 2, 4
• Children with physeal (growth plate) fractures may require different management - consider referral for Salter-Harris fractures except for selected nondisplaced types I and II 1
• For displaced fractures of the big toe, reduction should be performed before buddy taping, and referral may be necessary for stabilization 1

Weight-Bearing Instructions

• Weight-bearing status depends on fracture stability and patient pain tolerance 5
• For stable, nondisplaced fractures, protected weight-bearing in a rigid-sole shoe is typically allowed 1
• For more severe fractures, limited weight-bearing or use of crutches may be necessary initially 2