Treatment of Non-Displaced Great Toe Fracture
Non-displaced great toe fractures should be treated with immobilization using a 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. 1
Initial Management
Immobilization is the cornerstone of treatment for stable, non-displaced great toe fractures to optimize healing and prevent complications. 2 The great toe plays a critical role in weight-bearing and gait mechanics, making proper immobilization essential even for non-displaced fractures. 3
Immobilization Protocol
- Weeks 0-3: Use a short leg walking boot or cast with toe plate 1
- Weeks 3-7: Transition to a rigid-sole shoe for continued protection 1
- Total treatment duration: Typically 6-7 weeks for complete healing 1
Alternatively, buddy taping combined with a rigid-sole shoe can be used for stable, non-displaced fractures to limit joint movement, though this is generally reserved for lesser toe fractures. 2
Weight-Bearing Considerations
Weight-bearing as tolerated is generally acceptable for non-displaced great toe fractures, with activity level guided by the patient's pain tolerance. 3 The stability of the fracture and individual pain levels determine the appropriate degree of weight-bearing during the healing period. 3
Critical Pitfalls and Referral Indications
Immediate orthopedic referral is mandatory for the following scenarios, as these require specialized management to prevent long-term morbidity: 2
- Fractures involving >25% of the joint surface
- Unstable fractures
- Displaced fractures (often require surgical stabilization)
- Open fractures or significant soft tissue injury
- Fracture-dislocations
- Circulatory compromise
- Displaced intra-articular fractures
Special Considerations
Open physeal fractures of the great toe distal phalanx (Seymour fractures) are frequently missed and require urgent surgical treatment to prevent infection, nail deformity, and physeal arrest. 4 These injuries should be suspected when a physeal fracture is associated with bleeding or nail bed injury. 4
Stress fractures of the great toe sesamoids represent a distinct entity that typically does not heal with 6 weeks of immobilization and may require prolonged inactivity (4-6 months) or surgical excision. 5
Follow-Up
Patients should be monitored for complications including malunion, nonunion, arthritis, and infection. 3 Serial radiographs may be obtained to confirm appropriate healing, particularly if pain persists beyond the expected timeframe.