Workup and Treatment of a Stubbed Pinky Toe
For a stubbed fifth toe, initial assessment should focus on ruling out fracture through radiographic imaging (anteroposterior and oblique views), followed by appropriate treatment based on fracture status - typically buddy taping with a rigid-soled shoe for stable fractures. 1
Initial Assessment
- Evaluate for point tenderness at the fracture site or pain with gentle axial loading of the digit 1
- Assess for signs of open fracture including bleeding at the base of the nail, laceration proximal to the nail fold, or displaced fracture through the physis 2
- Check circulation, sensation, and movement of the affected toe 1
- Examine for nail bed injuries which may indicate an occult open fracture 3
Diagnostic Imaging
- Obtain anteroposterior and oblique radiographs to identify fractures, determine displacement, and evaluate adjacent phalanges 1
- Consider additional views if standard radiographs are inconclusive but clinical suspicion remains high 1
Treatment Algorithm
For Non-Displaced Fractures or No Fracture:
- Buddy tape the injured toe to an adjacent toe to limit movement and provide stability 1
- Recommend rigid-soled shoes to minimize joint movement during healing 1
- Apply ice for 15-20 minutes several times daily to reduce swelling 4
- Advise elevation of the foot when possible 1
- Recommend over-the-counter pain medications as needed 4
For Displaced Fractures:
- Attempt gentle reduction if the fracture is displaced 1
- After reduction, buddy tape to adjacent toe 1
- Consider referral for unstable reductions or significantly displaced fractures 1
Indications for Specialist Referral
- Circulatory compromise 1
- Open fractures 1
- Significant soft tissue injury 1
- Fracture-dislocations 1
- Displaced intra-articular fractures 1
- Fractures involving more than 25% of the joint surface 1
- Failed closed reduction 2
Special Considerations
- In children, most nondisplaced Salter-Harris types I and II fractures can be treated conservatively, but other types generally require referral 1
- Be vigilant for occult open fractures, which may occur when the nail bed is injured during the stubbing mechanism 3
- Hyperextension injuries may result in joint instability requiring more aggressive management 4, 5
Follow-up Care
- Most uncomplicated toe fractures heal within 4-6 weeks 1
- Recommend follow-up in 1-2 weeks to ensure proper healing 1
- Advise gradual return to normal activities as pain allows 4
- Monitor for signs of infection or delayed healing which may require further intervention 3