What is the treatment for a distal second toe tip fracture?

Treatment of Distal Second Toe Tip Fracture

For a distal second toe tip fracture, treat with buddy taping to an adjacent toe and a rigid-sole shoe for 4-6 weeks, with active motion of uninvolved digits encouraged from the outset. 1, 2, 3

Initial Management

• Buddy tape the injured toe to the third toe using appropriate technique to prevent skin complications, which occur in approximately 45% of cases when tape is applied directly to skin 4

  • Place padding (such as gauze or cotton) between the toes before taping to prevent skin maceration and necrosis 4
  • Use hypoallergenic tape and change regularly to minimize skin injury 4

• Provide a rigid-sole shoe to limit joint movement and protect the fracture during weight-bearing 2, 3

  • This allows for immediate weight-bearing as tolerated while protecting the fracture site 3

Active Motion Protocol

• Instruct the patient to perform active finger and toe motion exercises immediately for all uninvolved digits 1
  • Motion of adjacent digits does not adversely affect adequately stabilized toe fractures 1
  • Early motion prevents stiffness, which is one of the most functionally disabling complications and can be extremely difficult to treat after healing 1
  • This is a cost-effective intervention with significant impact on outcomes 1

Duration and Follow-up

• Continue buddy taping and rigid-sole shoe for 4-6 weeks 3

  • Lesser toe fractures (including the second toe) typically heal within this timeframe 3

• Radiographic follow-up is optional for stable, nondisplaced distal phalanx fractures 1

  • If obtained, imaging at approximately 3 weeks can confirm adequate healing 1

Important Caveats

• Monitor for low compliance with buddy taping, which occurs in 65% of patients 4

  • Reinforce proper technique and the importance of maintaining immobilization 4

• Watch for skin complications, particularly between the taped toes and at adhesive sites 4

  • These occur in up to 45% of cases and include skin breakdown, maceration, and rarely necrosis 4

• Referral is NOT typically needed for stable, nondisplaced distal phalanx fractures of lesser toes 2

  • Referral would only be indicated for open fractures, significant soft tissue injury, fracture-dislocations, or displaced intra-articular fractures 2