Conservative management in the acute stages, regardless of grade, consists of rest, ice, compression, and elevation (RICE). Taping is not recommended in the acute stages because of swelling and the risk of vascular compromise. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help minimize pain and inflammation. In some cases, a short leg cast with a toe spica in slight plantarflexion or a walker boot may be used for the first week to help decrease pain. Gradual range of motion begins in 3-5 days following injury.
After the acute stages, conservative management is based on the grade of injury, as follows:
Grade I injuries are treated by taping the great toe to the lesser toes to prevent movement of the hallux metatarsophalangeal (MTP) joint. Players may also consider using an insole containing a carbon fiber steel plate in the forefoot. As always, the overall goal is to restrict forefoot motion. Usually, persons with grade I injuries can return to play immediately, with only mild pain.
Grade 2 injuries are treated in the same way as grade 1 injuries are, but athletes may lose significantly more playing time. Lost playing time can range from 3-14 days. Use of a fracture walker and/or crutches is preferred.
Grade 3 injuries usually require long-term immobilization in a boot or cast rather than surgical intervention. Frequently, these injuries result in 2-6 weeks of missed playing time. Return to play is generally acceptable when 50-60 º of passive dorsiflexion is possible without pain.