Non-Displaced Closed Fractures of the Toes: Treatment Options

Non-displaced closed fracture of the toe?

Hello, Doctor.
I slipped and hit an object, resulting in pain and bruising in the last three toes of my left foot.
Four days after the injury, I visited an orthopedic specialist, and X-rays revealed fractures in both the fourth and fifth toes.
The doctor diagnosed them as non-displaced closed fractures of the proximal phalanges.
It was determined that surgery was not necessary, but no treatment was provided that day.
The doctor suggested that I wear a forefoot offloading shoe and recommended PRP therapy.
I would like to ask, in this situation, is PRP therapy necessary?

Ms. Li, 30~39 year old female. Ask Date: 2023/10/14

Dr. Shi Guozheng reply Orthopedics

Toe fractures typically heal on their own, and there is no evidence to suggest that platelet-rich plasma (PRP) treatment is effective.

Reply Date: 2023/10/14

More Info

Non-displaced closed fractures of the toes, such as the proximal phalanx fractures you described, are relatively common injuries that can occur from trauma, such as stubbing your toe or slipping and falling. In your case, the X-ray findings indicate that you have fractures in the fourth and fifth toes, which are classified as non-displaced, meaning the bone fragments have not moved out of their normal alignment.

Treatment Options for Non-Displaced Closed Toe Fractures
1. Conservative Management:
- Rest: It is crucial to avoid putting weight on the affected toes to allow for healing. Crutches or a walking aid may be recommended to minimize pressure on the toes.

- Ice Therapy: Applying ice to the injured area can help reduce swelling and alleviate pain. It is advisable to ice the area for 15-20 minutes every hour as needed.

- Elevation: Keeping the foot elevated can also help reduce swelling.

2. Footwear Modifications:
- Buddy Taping: This involves taping the injured toe to an adjacent toe for support. However, this should be done carefully to avoid further injury.

- Specialized Footwear: Wearing a stiff-soled shoe or a forefoot offloading shoe can help protect the toes during the healing process. This type of footwear reduces movement and provides stability.

3. Pain Management:
- Over-the-counter pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

4. Physical Therapy:
- Once the initial pain and swelling have subsided, gentle range-of-motion exercises may be introduced to prevent stiffness and promote healing.

PRP Treatment Consideration
Platelet-Rich Plasma (PRP) therapy involves injecting a concentration of platelets derived from your own blood into the injured area to promote healing. While PRP has shown promise in treating certain musculoskeletal injuries, its effectiveness in treating non-displaced toe fractures is still a topic of debate among medical professionals.

- Current Evidence: There is limited evidence to support the routine use of PRP for non-displaced fractures. Most toe fractures, especially non-displaced ones, tend to heal well with conservative management. The body has a natural ability to heal fractures without the need for advanced treatments like PRP.

- Consultation with Your Doctor: It is essential to discuss the potential benefits and risks of PRP therapy with your orthopedic doctor. They can provide personalized advice based on your specific injury and overall health.

Conclusion
In summary, non-displaced closed fractures of the toes typically heal well with conservative treatment, including rest, ice, elevation, and appropriate footwear. While PRP therapy may be an option, it is not universally recommended for this type of injury. It is crucial to follow your doctor's advice and monitor your symptoms closely. If you experience increased pain, swelling, or any other concerning symptoms, do not hesitate to seek further medical attention.

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