Fifth Toe Tuft Fracture Treatment
For a fifth toe tuft fracture, treat conservatively with buddy taping to the adjacent toe, a rigid-soled shoe or walking boot for comfort, and protected weight-bearing for 3-4 weeks. 1
Initial Assessment and Diagnosis
Obtain radiographs to confirm the diagnosis when a toe fracture is suspected, as trauma to the distal forefoot (metatarsal heads and toes) is not directly addressed by the Ottawa rules and requires imaging for documentation 1
Standard foot radiographs (anteroposterior, oblique, and lateral views) are the mainstay of initial imaging for suspected toe fractures 1
Clinical examination should assess for point tenderness, swelling, deformity, and ability to bear weight 1
Conservative Treatment Protocol
Tuft fractures of the fifth toe are inherently stable and should be managed non-operatively with the following approach:
Buddy taping: Tape the injured fifth toe to the fourth toe using soft padding between the toes to provide support and prevent excessive motion 2, 3
Protected weight-bearing: Allow weight-bearing as tolerated in a rigid-soled shoe or walking boot for comfort and protection 4
Immobilization duration: Continue protection for 3-4 weeks, which is typically sufficient for most minor toe fractures 5
Pain management: Use NSAIDs as needed for analgesia; early fracture stabilization through proper immobilization provides the most effective pain relief 6
Follow-Up Considerations
Minimize routine follow-up radiographs as they rarely change management in uncomplicated toe fractures:
Follow-up imaging before 6-8 weeks does not typically alter patient management for conservatively treated fifth metatarsal and toe fractures 7
Clinical assessment of pain, swelling, and functional improvement is more relevant than radiographic union for determining return to activities 4, 7
Patients can return to normal activities when clinically healed (typically 4-6 weeks), even if radiographic union is not yet complete 4
Key Clinical Pitfalls
Avoid over-immobilization: Prolonged rigid immobilization can lead to stiffness and muscle atrophy; buddy taping allows controlled motion while protecting the fracture 6
Do not apply Ottawa rules to toe injuries: These rules specifically exclude distal forefoot trauma, so radiographs should be obtained based on clinical suspicion alone 1
Distinguish from fifth metatarsal fractures: Ensure the fracture is truly in the toe (phalanx) and not the metatarsal base, as management differs significantly 2, 3