Toe fractures are relatively common and frequently managed by primary care and emergency physicians. Two reviews of orthopedic management in the primary care setting found that broken toes accounted for approximately 9 percent of fractures treated [1,2]. Of these, over 60 to 75 percent involved the smaller toes [3,4]. Although often dismissed as inconsequential, toe fractures that are improperly managed can lead to significant pain and disability. Treatment is generally straightforward, with excellent outcomes.
This topic review will discuss the evaluation and management of toe fractures in adults. Sesamoid fractures and other foot injuries are discussed elsewhere. (See "Sesamoid fractures of the foot" and "Metatarsal shaft fractures" and "Overview of running injuries of the lower extremity".)
By convention, toes and their respective metatarsals are numbered from one (great toe) through five (little toe). The second through fifth toes typically have three phalanges, while the great toe has two. Lesser toes, especially the fifth, may occasionally have only two phalanges (figure 1A-C).
Tendons and ligaments insert at the bases of each phalanx. The forces exerted by these structures may contribute to displacement of fracture fragments. Tendons, joint capsule, or other soft tissues may sometimes become interposed between fracture fragments, rendering them irreducible except by an open surgical approach.
The digital artery and nerve pass together along each side of each toe deep to the plantar surface. It is unusual for the neurovascular bundle to be injured as a consequence of a toe fracture, unless the fracture is open (eg, lawnmower injuries) or caused by a serious crush injury.