What is the treatment for a third toe midphalangeal (mid-phalangeal) fracture?

From the Guidelines

The treatment for a 3rd toe midphalange fracture typically involves conservative management with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as noted in a study published in the American Family Physician 1. The diagnosis of a midphalange fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.

Key Considerations

• The RICE protocol (Rest, Ice, Compression, and Elevation) should be followed to reduce pain and swelling.
• Pain can be managed with over-the-counter medications like acetaminophen or NSAIDs.
• The fractured toe should be buddy-taped to an adjacent toe to prevent movement and promote healing.
• A stiff-soled, comfortable shoe should be worn to minimize movement of the toe during healing.
• Most midphalange fractures heal within 4-6 weeks, with weight-bearing allowed as tolerated.

Special Considerations

• If the fracture is displaced, unstable, or involves the joint surface, orthopedic consultation may be necessary, and surgical intervention might be required, as indicated by the study 1.
• Patients should seek immediate medical attention if they experience increasing pain, numbness, color changes in the toe, or signs of infection.

From the Research

Treatment Options for 3rd Toe Midphalange Fracture

• The treatment for 3rd toe midphalange fracture can be conservative or operative, depending on the severity and stability of the fracture 2.
• Nondislocated fractures can be conservatively treated with good success, and long-term relief and immobilization including the ankle joint are unnecessary 3.
• For lesser toe fractures, treatment can include buddy taping and a rigid-sole shoe for four to six weeks 4.

Indications for Surgery

• Intra-articular layer formation, inclination >10°, and shortening between 3 mm and 5 mm are recommended as indications for surgery 3.
• Operative treatment of toe fractures is only rarely necessary, but may be required for unstable fracture patterns and those involving the articular surface 2.

Conservative Management

• Conservative management is the first line of treatment for metatarsalgia and lesser toe deformities, and can often obviate surgical intervention 5.
• Proper shoewear, orthoses, and inserts coupled with targeted physical therapy can alleviate most symptoms of metatarsalgia and lesser toe deformities 5.