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Toe Dislocation

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Other Names

  • Metatarsophalangeal joint dislocation
  • Interphalangeal joint dislocation
  • Pedal interphalangeal dislocation

Background

History

Epidemiology

  • Poorly described in the literature

Pathophysiology

  • General
    • Relatively uncommon, likely due to protection of footwear
  • Metatarsophalangeal joint dislocation
    • Most commonly the great toe
    • Mainly due to the postulation of its mobility and longer lever arm[1]
  • Interphalangeal joint dislocation
    • theorized that the injury mechanism is hyperextension and abduction[2]
  • Some may be irreducible with closed reduction
    • Likely due to plantar plate being interposed into the joint space[3]
    • Collateral ligaments are often intact

Associated Conditions


Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • History
    • Most patients will have a clear history of trauma
    • They will report pain, deformity
  • Physical Exam: Physical Exam Foot
    • On exam, deformity will often be obvious
    • It is important to confirm neurovascular status
  • Special Tests

Evaluation

Dorsolateral radiograph showing dislocation of the proximal interphalangeal joint (arrow)[4]

Radiographs


Classification

  • Not applicable

Management

Nonoperative

  • Closed reduction (Stienstra and Derner method)[5]
    • Dorsiflex the toe initially to exaggerate the deformity
    • Then, maintaining the toe in the dorsiflexed position, dorsal traction should be applied, followed by a plantarflexion motion
    • This sould produce a palpable and audible click of the repositioned IPJ.
  • Immobilization
    • Following reduction, patient should be placed in a Post Op Shoe

Operative

  • Indication
    • Dislocation is irreducible
    • Unable to maintain stability with closed reduction
    • Open dislocation
  • Technique
    • Open reduction, internal fixation

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Unknown

Complications

  • Redislocation
  • Inability to return to sport

See Also


References

  1. Nelson, TERRY L., and W. I. L. L. I. A. M. Uggen. "Irreducible dorsal dislocation of the interphalangeal joint of the great toe." Clinical orthopaedics and related research 157 (1981): 110-112.
  2. Katayama, M. O. T. O. F. U. M. I., Y. Murakami, and H. Takahashi. "Irreducible dorsal dislocation of the toe. Report of three cases." JBJS 70.5 (1988): 769-770.
  3. Miki, Takaakj, Takao Yamamuro, and Tosiyuki Kitai. "An irreducible dislocation of the great toe. Report of two cases and review of the literature." Clinical orthopaedics and related research 230 (1988): 200-206.
  4. Lui T H. Post-traumatic toe deformity in a child BMJ 2019; 365 :l2224 doi:10.1136/bmj.l222
  5. Stienstra, J. J., and R. Derner. "Closed reduction of a proximal interphalangeal joint dislocation." The Journal of foot surgery 29.4 (1990): 385-387.
Created by:
John Kiel on 30 November 2021 17:44:04
Authors:
Last edited:
4 October 2022 12:37:47