Should an X-ray (X-radiation imaging) be done to rule out a fracture in the right 5th toe?

X-ray for Suspected 5th Toe Fracture

X-ray imaging is indicated for suspected fractures of the 5th toe when there is point tenderness or pain with gentle axial loading of the digit, as radiographs are necessary to document or rule out a fracture. 1

Clinical Decision Making

• The Ottawa Ankle Rules do not specifically address toe injuries, so their criteria cannot be used to rule out toe fractures 1
• Radiographs should be obtained when a toe fracture is clinically suspected based on:
  • Point tenderness at the fracture site 2
  • Pain with gentle axial loading of the digit 2
  • History of crushing injury or axial force (such as stubbing the toe) 2

Imaging Approach

• Standard radiographic protocols for suspected toe fractures should include:
  • Anteroposterior view 2
  • Oblique view 2
• These views are most useful for:
  • Identifying fractures 2
  • Determining displacement 2
  • Evaluating adjacent phalanges and digits 2

Treatment Implications

• X-ray findings directly guide treatment decisions:
  • Stable, nondisplaced fractures can be treated with buddy taping and a rigid-sole shoe 2
  • Displaced fractures may require reduction 2
  • First toe fractures that are unstable or involve more than 25% of the joint surface require referral 2
  • Fracture-dislocations require referral 2

Potential Pitfalls

• Failure to obtain radiographs for suspected toe fractures may lead to:
  • Missed diagnoses 1
  • Improper treatment 1
  • Delayed healing or complications 3
• While the Ottawa rules are highly sensitive for midfoot and ankle fractures, they do not extend to toe injuries, creating a potential diagnostic gap if relied upon exclusively 1

Follow-up Considerations

• Follow-up radiographs before 6-8 weeks generally do not alter patient management for conservatively managed fractures 3
• Clinical healing may precede radiological healing, with many patients being discharged based on clinical improvement rather than complete radiological union 3