Broken Toe Treatment
For a suspected broken toe, obtain standard three-view radiographs (anteroposterior, lateral, and oblique) to confirm the diagnosis, then treat most stable, nondisplaced fractures with buddy taping and a rigid-sole shoe for 4-6 weeks. 1
Initial Diagnostic Approach
When to obtain radiographs:
- Order imaging if there is point tenderness at the fracture site or pain with gentle axial loading of the digit 1, 2
- Note that toe fractures are not directly addressed by the Ottawa foot rules, which focus on midfoot injuries 1
- Standard three-view radiographs have 99% sensitivity for detecting foot fractures 3
Imaging technique:
- Obtain anteroposterior, lateral, and oblique views 3, 2, 4
- These views are most useful for identifying fractures, determining displacement, and evaluating adjacent structures 2
Treatment Algorithm Based on Fracture Type
Great Toe (Hallux) Fractures
These require more aggressive management due to their weight-bearing role:
- Stable, nondisplaced fractures: Short leg walking boot or cast with toe plate for 2-3 weeks, then transition to rigid-sole shoe for additional 3-4 weeks 4, 5
- Displaced fractures: Often require orthopedic referral for stabilization 2
- Unstable fractures or those involving >25% of joint surface: Immediate referral 2
Lesser Toe Fractures (2nd-5th toes)
Most can be managed conservatively:
- Stable, nondisplaced fractures: Buddy taping to adjacent toe plus rigid-sole shoe for 4-6 weeks 2, 4, 5
- Displaced fractures: Perform closed reduction, then buddy tape and use rigid-sole shoe 2, 4
Immediate Referral Criteria
Refer to orthopedics or podiatry for:
- Circulatory compromise or signs of vascular injury 2, 5
- Open fractures 2, 5
- Significant soft tissue injury 6, 2
- Fracture-dislocations 2
- Displaced intra-articular fractures 2
- Great toe fractures that are unstable or involve >25% of joint surface 2
- Most pediatric physeal fractures (except selected nondisplaced Salter-Harris types I and II) 2
Critical Pitfalls to Avoid
Turf toe (plantar plate disruption):
- Consider this diagnosis if there is a history of hyperextension injury to the great toe 6
- May require weight-bearing radiographs with sesamoid axial views for proper evaluation 6
- This is a soft tissue injury that can be missed if you only focus on bony injury 1, 6
Lisfranc injury masquerading as toe fracture:
- If pain extends to the midfoot or there is mechanism involving hyperflexion/twisting, obtain full foot radiographs 7
- Weight-bearing views are essential as non-weight-bearing images miss subtle injuries 7
Compartment syndrome:
- Rare but serious complication requiring immediate fasciotomy 5, 8
- Watch for severe pain out of proportion to injury, tense swelling, and pain with passive toe extension 5
Follow-Up Considerations
Most stable toe fractures do not require fracture clinic follow-up:
- Research shows that undisplaced, stable toe fractures rarely develop complications requiring intervention 9
- Only 2 of 65 patients (3%) with toe fractures required surgery in one study 9
- Consider discharge with return precautions rather than routine follow-up for simple, stable fractures 9
When to obtain advanced imaging: