Initial Treatment for Lesser Toe Fractures
The initial treatment for a lesser toe fracture should be buddy taping and a rigid-sole shoe to limit joint movement for 4-6 weeks. 1, 2
Assessment and Diagnosis
- Point tenderness at the fracture site or pain with gentle axial loading of the digit are the most common clinical findings in toe fractures 1
- Anteroposterior and oblique radiographs are generally most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges 1
- The Ottawa Ankle Rules do not specifically address toe fractures but can help rule out more serious ankle injuries when trauma affects both areas 3
Treatment Algorithm for Lesser Toe Fractures
Stable, Non-displaced Fractures
- Buddy taping (taping the injured toe to an adjacent uninjured toe) 1, 2
- Rigid-sole shoe for 4-6 weeks to limit joint movement 2
- No need for long-term relief or immobilization including the ankle joint 4
- Progressive mobility as tolerated after initial immobilization 2
Displaced Fractures
- Reduction followed by buddy taping for lesser toes 1
- After reduction, use of a rigid-sole shoe for 4-6 weeks 2
- Monitor for proper alignment during healing 1
When to Refer to a Specialist
Immediate referral is indicated in patients with:
- Circulatory compromise 1
- Open fractures 1
- Significant soft tissue injury 1
- Fracture-dislocations 1
- Displaced intra-articular fractures 1
- Fractures of the first toe (great toe) that are unstable or involve more than 25% of the joint surface 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 1
- Operative treatment of toe fractures is only rarely necessary 4
- Intra-articular layer formation, inclination >10°, and shortening between 3-5 mm may be indications for surgical intervention 4
Healing Timeframe
- Most lesser toe fractures heal within 4-6 weeks with proper immobilization 2
- Patients can typically resume normal shoe wear and activities after this period 2, 5
- For avulsion fractures, bony healing may take up to 16 weeks, but normal shoe wear may be possible earlier (around 10 weeks) 5
Common Pitfalls to Avoid
- Failing to identify associated injuries, especially in high-energy trauma 1
- Inadequate immobilization leading to malunion or prolonged pain 2
- Overlooking potential complications such as post-traumatic arthritis in intra-articular fractures 1
- Unnecessary over-treatment with casting or prolonged immobilization for simple, stable fractures 4