Management of Nondisplaced Fifth Toe Fractures
Nondisplaced fifth toe fractures should be treated conservatively with buddy taping to the adjacent toe and a rigid-sole shoe, allowing progressive weight-bearing as tolerated over 4-6 weeks. 1, 2
Initial Assessment and Diagnosis
- Confirm the diagnosis with anteroposterior and oblique radiographs to identify the fracture, assess for displacement, and evaluate adjacent structures 1
- Examine for point tenderness at the fracture site and pain with gentle axial loading of the digit 1
- Assess neurovascular status and soft tissue integrity to rule out complications requiring referral 1
Conservative Treatment Protocol
For stable, nondisplaced toe fractures, the treatment consists of:
- Buddy taping: Tape the injured fifth toe to the fourth toe with padding between the digits to prevent skin maceration 1, 2
- Rigid-sole shoe: Use a stiff-soled shoe or walking boot to limit joint movement and protect the fracture 1, 2
- Weight-bearing: Allow weight-bearing as tolerated immediately; prolonged immobilization is unnecessary and may lead to stiffness and muscle atrophy 3, 4
- Duration: Continue buddy taping and protective footwear for 4-6 weeks 2
Pain Management
- Early fracture stabilization through proper immobilization with buddy taping and rigid footwear provides the most effective pain relief 3
- NSAIDs can be used for additional analgesia as needed 1
Follow-Up Care
- Routine serial radiographs are not necessary for stable, nondisplaced fractures healing appropriately 5
- Repeat imaging should only be obtained if there is new trauma, increased pain, loss of range of motion, or neurovascular symptoms 5
- Clinical follow-up at 2-3 weeks to assess healing progress and ensure proper alignment is reasonable 2
Indications for Referral
Refer to orthopedic surgery if any of the following are present:
- Circulatory compromise or neurovascular injury 1
- Open fractures or significant soft tissue injury 1
- Fracture-dislocations 1
- Displaced intra-articular fractures 1
- Fractures involving growth plates (physeal fractures) in children, except selected nondisplaced Salter-Harris types I and II 1
Key Clinical Pitfalls to Avoid
- Do not immobilize the ankle joint: Long-term immobilization including the ankle is unnecessary and counterproductive for toe fractures 4
- Do not confuse with fifth metatarsal fractures: Fifth toe (phalanx) fractures have different treatment than fifth metatarsal fractures, which may require more aggressive management depending on location 6, 7
- Ensure adequate padding with buddy taping: Place gauze or cotton between toes to prevent skin breakdown 1