What is the treatment for a toe fracture?

Treatment for Toe Fractures

Most toe fractures can be managed conservatively with buddy taping and a rigid-sole shoe for four to six weeks. 1

Initial Assessment and Diagnosis

• Toe fractures are typically caused by crushing injuries or axial forces (such as stubbing a toe), with joint hyperextension and stress fractures being less common 2
• Patients usually present with point tenderness at the fracture site or pain with gentle axial loading of the digit 2
• Anteroposterior and oblique radiographs are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges 2, 1
• The Ottawa foot and ankle rules can help determine the need for radiography after acute foot trauma 3, 4

Treatment Approach

Conservative Management (for stable, non-displaced fractures)

• Buddy taping (taping the injured toe to an adjacent uninjured toe) and a rigid-sole shoe to limit joint movement 2, 1
• Weight-bearing as tolerated based on pain level 1
• Duration of treatment: 2-6 weeks for most toe fractures 1

Great Toe (Hallux) Fractures

• Require special attention due to the great toe's important role in weight-bearing 1, 5
• Treatment: Short leg walking boot or cast with toe plate for 2-3 weeks, followed by a rigid-sole shoe for an additional 3-4 weeks 6
• Displaced fractures of the first toe often require referral for stabilization of the reduction 2

Lesser Toe Fractures

• Stable, non-displaced fractures: Buddy taping and rigid-sole shoe for 4-6 weeks 6
• Displaced fractures: Reduction followed by buddy taping 2

Indications for Referral

• Circulatory compromise 2
• Open fractures 2
• Significant soft tissue injury 2
• Fracture-dislocations 2
• Displaced intra-articular fractures 2
• Fractures of the first toe that are unstable or involve more than 25% of the joint surface 2
• Most children with fractures of the physis (growth plate) 2

Rehabilitation and Follow-up

• Early introduction of physical training and muscle strengthening followed by balance training to prevent complications from prolonged immobilization 3
• Regular radiographic assessment to ensure proper healing and alignment 3

Special Considerations

• For patients with diabetes and neuropathy, special attention should be paid to offloading the foot to prevent complications 3
• Complications may include arthritis, infection, malunion or nonunion, and compartment syndrome 1

Treatment Algorithm

1. Assess fracture stability and displacement with appropriate radiographs
2. For stable, non-displaced fractures: Buddy taping and rigid-sole shoe
3. For displaced fractures of lesser toes: Reduction followed by buddy taping
4. For great toe fractures: Short leg walking boot/cast with toe plate, then rigid-sole shoe
5. For any concerning features (open fracture, circulatory compromise, etc.): Immediate orthopedic referral
6. Follow up in 2-3 weeks to ensure proper healing