What is the management for a fractured fifth toe?

Management of Fractured Fifth Toe

Most fractured fifth toes can be effectively managed with buddy taping and a rigid-sole shoe for 2-6 weeks, which provides adequate stabilization while allowing for proper healing. 1, 2

Initial Assessment

• Radiographs with anteroposterior, lateral, and mortise views should be obtained to confirm the diagnosis and determine if the fracture is displaced 3, 4
• Weight-bearing radiographs, when possible, provide important information about fracture stability 4
• Assess for signs that would require referral rather than conservative management, such as circulatory compromise, open fractures, or significant displacement 1

Treatment Algorithm

For Stable, Non-displaced Fifth Toe Fractures:

• Primary treatment: Buddy taping to the adjacent fourth toe and a rigid-sole shoe 1, 2
  • Clean and dry both the injured toe and the adjacent toe before taping 5
  • Apply tape firmly enough to provide stability but not so tight as to compromise circulation 5
  • Check capillary refill after taping to ensure adequate circulation 5
• Duration: 2-6 weeks depending on healing progress and pain levels 2
• Weight-bearing: As tolerated based on pain 2

For Displaced Fifth Toe Fractures:

• Gentle reduction followed by buddy taping and a rigid-sole shoe 1
• If reduction is unstable or cannot be maintained, orthopedic referral may be necessary 1

Indications for Referral

Immediate referral is indicated for:

• Circulatory compromise 1
• Open fractures 1
• Significant soft tissue injury 1
• Fracture-dislocations 1
• Unstable displaced fractures that cannot be adequately reduced 1

Pain Management and Additional Care

• Ice therapy: Apply melting iced water through a wet towel for repeated periods of 10 minutes (not continuous application) to reduce pain and swelling 6
• Elevation of the affected foot when resting to reduce swelling 1
• Appropriate analgesics as needed for pain control 2

Follow-up and Rehabilitation

• Clinical reassessment at 2-3 weeks to ensure proper healing 2
• Progressive weight-bearing as tolerated after the immobilization period 4
• Early introduction of physical training and muscle strengthening followed by balance training once healing is adequate 3
• Avoid prolonged immobilization to prevent stiffness and muscle atrophy 3

Common Pitfalls and Complications

• Avoid manipulation of the ankle prior to radiographs in the absence of neurovascular deficit 4
• Be aware that reflex activity and motor function may be impaired for up to 30 minutes following ice treatment, potentially making patients more susceptible to injury during this period 6
• Monitor for signs of delayed union, malunion, or nonunion, which may require additional intervention 7
• For patients with diabetes, monitor closely for signs of skin breakdown or infection at the fracture site 4

Most fifth toe fractures heal well with conservative management, and complications are rare when appropriate treatment protocols are followed 2.