Management of Non-Displaced Great Toe Fracture in Children

Recommended Treatment Approach

Immobilization with buddy taping and a rigid-sole shoe is recommended for non-displaced great toe fractures in children, though conservative management without rigid immobilization may be equally effective and associated with fewer complications, according to the American Academy of Orthopaedic Surgeons 1

Pediatric patients have exceptional remodeling potential, which mitigates the risk of residual deformity even with initial acceptance of some deformity, as stated by the American Academy of Orthopaedic Surgeons 2, 3

At 19 months, the child is in the toddler age range where fractures typically heal rapidly with minimal complications, and communication of pain is limited, so monitor for behavioral changes including anxiety, agitation, and increased analgesic requirements, as recommended by the Anaesthesia journal 4

Routine serial radiographs are NOT necessary for stable, non-displaced fractures healing appropriately, and repeat imaging should only be obtained if there is new trauma, increased pain, loss of range of motion, or neurovascular symptoms, according to the American Academy of Orthopaedic Surgeons 1
Repeat imaging should be considered if initial radiographs are equivocal but clinical suspicion remains high, with repeat films in 10-14 days, as suggested by the American Academy of Orthopaedic Surgeons 5

Avoid prolonged immobilization, which may lead to unnecessary stiffness, muscle atrophy, and delayed return to activities, as warned by the American Academy of Orthopaedic Surgeons 2
Do not routinely obtain follow-up radiographs unless clinically indicated, as this increases healthcare contacts without changing management, according to the American Academy of Orthopaedic Surgeons 1