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Toe Dislocation
From WikiSM
Contents
Other Names
- Metatarsophalangeal joint dislocation
- Interphalangeal joint dislocation
- Pedal interphalangeal dislocation
Background
- This page refers to dislocations of the 'toe'
- Specifically, of the Metatarsophalangeal joint and Interphalangeal Joint
- Toe Fractures are discussed separately
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
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
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
- Standard Radiographs Foot
- Typically sufficient to make the diagnosis
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
- Internal
- External
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Lui T H. Post-traumatic toe deformity in a child BMJ 2019; 365 :l2224 doi:10.1136/bmj.l222
- ↑ 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
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Last edited:
4 October 2022 12:37:47
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