Management of Great Toe Fractures

Initial Diagnostic Approach

Plain radiographs, including anteroposterior, lateral, and oblique views, are the initial imaging study of choice for suspected great toe fractures, as recommended by the American College of Radiology 1, 2, 3
Radiographs should be obtained when a toe fracture is clinically suspected based on point tenderness at the fracture site or pain with gentle axial loading, according to the American College of Radiology 2, 3

Significant soft tissue injury is an indication for immediate referral, as stated by the American College of Radiology 4

Turf toe (plantar plate disruption) should be considered if there is a history of hyperextension injury, and may require weight-bearing radiographs with sesamoid axial views, as recommended by the American College of Radiology 1, 4
Patients with persistent pain beyond expected healing time may require advanced imaging (MRI) to evaluate for occult injuries or complications, according to the American College of Radiology 1, 4

The American College of Cardiology is not relevant here, however, Circulation journal recommends assessing for signs that would require referral rather than buddy taping, such as circulatory compromise or blue/purple/pale appearance of the toe, which requires immediate emergency response 5
Before buddy taping, clean and dry both the injured toe and the adjacent second toe, and check for any open wounds - if present, cover with a clean dressing before taping to prevent contamination and infection 5
Apply the tape firmly enough to provide stability but not so tight as to compromise circulation, and assess circulation after taping by checking capillary refill of the toes to ensure adequate circulation 5

The proper taping method involves wrapping non-elastic adhesive tape around both the fractured big toe and the second toe in a figure-of-eight pattern, although the exact method is not specified in the provided citations, the importance of maintaining circulation is emphasized 5