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Toe Fractures

By Danielle Campagne, MD , Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Patient Education

Most toe fractures are minimally displaced and require only taping to an adjacent toe (buddy taping).

Pain, swelling, and tenderness are common. Subungual hematoma (between the nail plate and nail bed) is also common, particularly when the mechanism is a crush injury.

Diagnosis

  • If certain injuries are suspected, x-rays

Unless rotational deformity or joint involvement is suspected or the proximal phalanx of the great toe (hallux) is injured, x-rays are usually unnecessary because treatment is the same whether fracture is present or not. When x-rays are indicated, anteroposterior, lateral, and oblique views of each toe are taken.

Treatment

  • Buddy taping

  • For certain injuries, reduction and fixation

Treatment of a toe fracture involves taping the injured toe to an adjacent toe (dynamic splinting, or buddy taping).

If the toe is displaced or deformed, reduction may be needed before buddy taping. Fixation is sometimes indicated (eg, for fractures with marked displacement or rotational deformity of the great toe).

If the great toe is fractured, patients should not put weight on the injured foot and should wear a hard-soled postoperative shoe; follow-up appointments should be scheduled with an orthopedic surgeon.

Key Points

  • A fractured toe is usually painful and swollen; a subungual hematoma commonly forms, particularly when the toe has been crushed.

  • Take anteroposterior, lateral, and oblique views of each toe if rotational deformity or joint involvement is suspected or if the proximal phalanx of the great toe is injured; otherwise x-rays are usually unnecessary because treatment is the same whether fracture is present or not.

  • Tape the injured toe to an adjacent toe; if the toe is displaced or deformed, reduction may be needed first.

  • If the great toe is fractured, instruct patients not to put weight on the injured foot, treat with a hard-soled postoperative shoe, and make sure patients schedule follow-up appointments with an orthopedic surgeon.

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