Authors of section

Authors

Richard Buckley, Andrew Sands, Michael Castro, Christina Kabbash

Executive Editors

Joseph Schatzker, Richard Buckley

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Nonoperative treatment

1. Indication for nonoperative treatment

If it is a closed injury and there is no serious displacement, the toe is best treated by strapping it to the adjacent uninjured toe (buddy taping).

Surgical stabilization is necessary when the fractures are open or grossly displaced.

2. Patient positioning

Supine position

The patient is placed supine on a radiolucent table. A well-padded bump is placed under the ankle and heel of the surgical foot to elevate the foot for improved access and stabilize against rotation.

nonoperative treatment

The nonoperative leg is secured with safety straps or taping.

To correct for external rotation of the leg and foot, a well-padded bump may be placed under the ipsilateral hip (a).

Alternatively, to correct for internal rotation of the leg and foot, a well-padded bump is placed under the contralateral hip (b).

Supine position

3. Reduction

If a toe is dislocated, it is reduced by exaggerating the deformity and then applying traction and reversing the mechanism of injury.

nonoperative treatment

4. Treatment

Alignment can be maintained by buddy taping. The skin is cleaned with alcohol to remove oils and 5-10 mm wide straps are fixed in a loop around the toes. Gauze may be placed between the toes to avoid maceration of the skin.
The MTP joint must be immobilized in an anatomical position to avoid a dorsiflexion contracture.

2nd 5th row proximal phalanx head small fragment

5. Aftercare

A stiff soled orthosis like a flat, rigid sole shoe is used to protect the reduction and allow healing.

The symptoms usually settle over the first few weeks. The tape should be changed frequently to prevent maceration between the toes. Most patients are capable of doing this themselves.

Taping can be abandoned after 4-5 weeks.

nonoperative treatment