Work-up of a Stubbed Pinky Toe

For a stubbed fifth toe, radiographs are appropriate if a fracture is suspected to document or rule out the injury. 1

Initial Assessment

Evaluate for signs of fracture including localized tenderness, swelling, and pain with weight-bearing 1
Assess skin integrity and musculoskeletal deformities in a well-lit room 1
Examine for any open wounds or signs of infection 1
Check neurovascular status including sensation and circulation to the toe 1

Plain radiographs are the mainstay of initial imaging for suspected toe fractures 1
A three-view radiographic study (anteroposterior, oblique, and lateral) is typically recommended 1
CT is not routinely used as the first imaging study for toe injuries 1
MRI is not routinely indicated for initial evaluation of toe injuries 1
Ultrasound has shown less successful results compared to radiographic evaluation, with 90.9% sensitivity and specificity for detecting fractures 1

Apply ice through a wet towel for repeated periods of 10 minutes to reduce pain and swelling 2
Target temperature reduction of 10-15 degrees C in the affected area 2
Use compression with an elastic bandage to help control swelling 3
Elevate the foot above heart level when possible 3
Avoid barefoot walking both indoors and outdoors 4
Use open-backed shoes to reduce pressure on the affected area 4

Well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure 1
For bony deformities (e.g., hammertoes), extra wide or deep shoes may be needed 1
For extreme bony deformities that cannot be accommodated with appropriate footwear, custom-molded shoes may be required 1

For patients with diabetes, a stubbed toe requires more careful monitoring due to increased risk of complications 1
Patients with peripheral neuropathy, foot deformities, or peripheral vascular disease need more thorough evaluation after toe injury 1
Patients with visual difficulties, physical constraints, or cognitive problems may need assistance with proper foot monitoring and care 1

Monitor for signs of healing including decreased pain and swelling 1
If pain persists beyond 7-10 days or worsens, consider follow-up imaging to rule out occult fracture 1
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 further injury 2

Failing to obtain radiographs when a fracture is suspected can lead to improper healing and chronic pain 1
Overlooking associated injuries to adjacent toes or metatarsals 1
Inadequate pain control leading to altered gait mechanics and secondary injuries 2
Applying ice continuously rather than intermittently, which can compromise skin integrity 2