What is the primary care for a broken toe?

Management of Broken Toes in Primary Care

For most broken toes, treatment consists of buddy taping and wearing a rigid-soled shoe for 4-6 weeks, with referral indicated for fractures with complications or those involving the great toe that are unstable or displaced. 1, 2

Initial Assessment

• Toe fractures commonly result from crushing injuries, axial forces (like stubbing a toe), or direct trauma 1

• Evaluate for signs requiring immediate referral:

  • Circulatory compromise or blue/purple/pale appearance of the toe 3
  • Open fractures or significant soft tissue injury 1
  • Displaced intra-articular fractures 1
  • Fracture-dislocations 1

• Obtain anteroposterior, lateral, and oblique radiographs to identify fractures, determine displacement, and evaluate adjacent structures 1, 2

• Weight-bearing radiographs are preferred when possible, as they may detect abnormalities not apparent on non-weight-bearing images 4

Treatment Based on Fracture Type

Lesser Toe Fractures (2nd-5th toes)

• For stable, nondisplaced fractures:

  • Buddy tape the injured toe to an adjacent toe in a figure-of-eight pattern 3, 1
  • Prescribe a rigid-sole shoe to limit joint movement for 4-6 weeks 2, 5
  • Clean and dry both toes before taping, and cover any open wounds with a clean dressing 3
  • Apply tape firmly enough for stability but not so tight as to compromise circulation 3

• For displaced fractures of lesser toes:

  • Perform manual reduction followed by buddy taping 1
  • Monitor for adequate reduction with follow-up radiographs 5

Great Toe (Hallux) Fractures

• Great toe fractures require special attention due to their role in weight-bearing and gait 2

• Treatment options include:

  • Short leg walking boot or cast with toe plate for 2-3 weeks, then a rigid-sole shoe for an additional 3-4 weeks 5
  • For stable, nondisplaced fractures, buddy taping to the second toe and a rigid-sole shoe may be sufficient 1

• Refer to orthopedics or podiatry for:

  • Fractures involving more than 25% of the joint surface 1
  • Unstable or displaced fractures requiring stabilization 1, 5
  • Seymour fractures (open physeal fractures of the distal phalanx with nail bed injury) in children 6

Follow-up Care

• Assess circulation after taping by checking capillary refill 3
• Advise patients to elevate the foot when possible to reduce swelling 5
• Recommend non-steroidal anti-inflammatory drugs (NSAIDs) for pain management 5
• Follow up in 1-2 weeks to ensure proper healing and alignment 2
• Weight-bearing status depends on fracture stability and patient's pain tolerance 2

Special Considerations

• Children with physeal (growth plate) fractures often require referral, though selected nondisplaced Salter-Harris types I and II fractures may be treated by primary care physicians 1
• Diabetic patients with neuropathy require special attention as they may not present with typical pain symptoms and have higher risk of complications 4
• Most toe fractures heal without complications, but be aware of potential issues such as malunion, arthritis, or chronic pain 2

When to Refer

• Immediate referral for:
  • Open fractures or significant soft tissue injury 1
  • Circulatory compromise 3, 1
  • Fracture-dislocations 1
  • Displaced intra-articular fractures 1
  • Great toe fractures that are unstable or involve >25% of joint surface 1
• Delayed referral for:
  • Fractures that fail to heal with conservative management 5
  • Development of chronic pain or functional limitation 2