What is the treatment for a fractured and displaced 5th toe?

Treatment of Fractured and Displaced 5th Toe

For a fractured and displaced 5th toe, perform closed reduction followed by buddy taping to the 4th toe and immobilization in a rigid-sole shoe for 4-6 weeks, with weight-bearing as tolerated. 1

Initial Management

Reduction Technique

• Displaced fractures of the lesser toes (including the 5th toe) require closed reduction followed by buddy taping. 1
• Reduction is performed by applying gentle longitudinal traction along the axis of the toe to realign the fracture fragments 1
• After reduction, the toe should be buddy-taped to the adjacent 4th toe using soft padding between the digits to prevent skin maceration 1

Immobilization Strategy

• Use a rigid-sole shoe (also called hard-soled shoe) to limit joint movement and protect the fracture during healing. 1
• The rigid sole prevents excessive flexion and extension at the metatarsophalangeal and interphalangeal joints, which could displace the fracture 1
• Weight-bearing is permitted as tolerated in the rigid-sole shoe 1

Duration of Treatment

• Maintain buddy taping and rigid-sole shoe immobilization for 4-6 weeks until clinical and radiographic healing is evident. 1
• Clinical healing is indicated by resolution of point tenderness and ability to bear weight without pain 1
• Radiographic follow-up should be obtained at approximately 3 weeks to assess fracture alignment and healing 2

Indications for Referral

Immediate orthopedic referral is required for: 1

• Open fractures with soft tissue compromise
• Fractures with circulatory compromise
• Fracture-dislocations that cannot be reduced or maintained with closed techniques
• Displaced intra-articular fractures
• Fractures with significant soft tissue injury

Important Caveats

First Toe vs Lesser Toes

• The 5th toe can typically be managed conservatively as described above 1
• In contrast, displaced fractures of the first toe (great toe) often require referral for surgical stabilization due to its weight-bearing importance 1

Pediatric Considerations

• Most children with physeal (growth plate) fractures should be referred to orthopedics 1
• Selected nondisplaced Salter-Harris type I and II fractures may be managed by primary care physicians with buddy taping and rigid-sole shoes 1

Assessment for Associated Injuries

• Use the Ottawa Ankle Rules to exclude more serious ankle injuries when trauma affects both the toe and ankle regions 3
• Obtain anteroposterior and oblique radiographs to identify the fracture pattern, assess displacement, and evaluate adjacent phalanges 1

Expected Outcomes

• Most stable, properly reduced 5th toe fractures heal without complications when treated with buddy taping and rigid-sole shoe immobilization 1
• Patients typically return to normal activities within 4-6 weeks 1
• Complications are rare with appropriate conservative management of nondisplaced or adequately reduced fractures 1