In a nutshell, the donut spare will suffice nicely in case of a flat and it is capable of 45 MPH as indicated on a bright red sticker attached to the donut rim itself. As VX-KAT said, the key is to only use the donut on the FRONT axle (never the rear); and if a flat occurs on the rear, then a good tire must be relocated from the front. This is because the TOD system is very sensitive to mis-matched tires on the rear axle, and is much more forgiving to mis-matched tires on the front axle (just get the original flat fixed ASAP).
Is it worth getting a full-size spare??? I would say, NO.
Just ask yourself these questions:
o When was the last time you ever got a flat???
o If you did get a flat-- how close were you to civilization and able to quickly find a nearby service station/repair shop???
o Do you constantly want to lug around a heavy and bulky full-size spare, when the OEM donut will easily suffice on the front axle in a rare emergency and be able to limp yourself back home or to a nearby repair shop???
Today's truck tires are very durable and tough, and are very unlikely to ever get a flat unless you are in the extreme outback wilderness. If you do ever plan on venturing out in the dead of wilderness; then yes, take along a full-size spare for the occasion (it can just be a cheapo rim, with a skinny tire having the same O.D.). Once you're back home in the urban environment, then toss the cheapo full-size spare back into the garage.
Constantly lugging around a heavy, bulky full-size spare tire 24/7 is a total waste of cargo space (interior located), creates excessive wind-drag (roof-top located), and lowers your MPG overall with the extra additional weight. It simply isn't worth the hassle in today's modern world of cell phones, AAA, and available mobile tire repair services that will gladly come out to your roadside location to fix your existing flat (that is if you ever get a flat in your lifetime). Don't waste your money on a full-size spare unless you plan on venturing deep into the outback wilderness. Use the OEM donut on the front axle for that rare emergency that will likely never happen.
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