Disorders of the great toe in dancers

Although often neglected in the consideration of dancing and sports injuries, the great toe is as important as the other large joints of the lower limb. Many injuries to the great toe are associated with technical faults occurring during dancing, and these should be corrected or the injury will recur. It is also important that when a dancer presents with an injury elsewhere, the possibility of faults at the great toe be considered.

Isolated dorsal dislocation of the second metatarsophalangeal joint

A rare case of dorsal dislocation of the second metatarsophalangeal joint is presented with diagnosis, treatment, and long-term follow up evaluation. The unusual mechanism of injury and obstacle to reduction are described.

Traumatic dislocations of the first metatarsophalangeal joint

The mechanics, anatomy, and pathomechanics of traumatic dorsal dislocation of the first metatarsophalangeal joint are discussed. There are two basic types of dislocations. In Type I, dislocation of the hallux with the sesamoids occurs without disrupting the sesamoid mass. Such cases are usually irreducible on closed reduction, the metatarsal head being incarcerated by the conjoined tendons with their intact sesamoids. In Type II, there is either associated disruption of the intersesamoid ligament (Type IIA) or a transverse fracture of one of the sesamoids (Type IIB). In Type II, the sesamoid disruption usually permits closed reduction.

Avulsion fracture of the fibular sesamoid in association with dorsal dislocation of the metatarsophalangeal joint of the hallux: report of a case and review of the literature

A case of avulsion fracture of the lateral sesamoid is reported in association with dislocation of themetatarsophalangeal joint of the hallux. The radiographic criteria to establish the diagnosis of fracture in sesamoid bones are outlined. Review of the literature reveals only one other reported case associated with a hallux dislocation, and in that case, the radiographic diagnosis was not clearly established.

A technique for management of traumatic rupture of the equine suspensory apparatus

Problems involving the management of acute traumatic rupture of the equine suspensory apparatus include loss of blood flow to the foot, proper immobilization, and pressure sores from casts. A technique utilizing a board splinting device attached to the affected limb at the toe and subsequent corrective shoe support provides immobilization, prevents dropping of the fetlock, can be applied to the standing animal, and allows frequent changing of the bandages, if necessary.

Irreducible dislocation of the metatarsophalangeal joints of the foot

An unusual dislocation of the metatarsophalangeal joints of the third, fourth, and fifth toes with fractures of the neck of the second metatarsal bone occurred in a 23-year-old man. Hyperextension of the metatarsophalangeal joints is the mechanism of injury and is substantiated by the anatomic investigation. The metatarsal head is trapped between the fibrocartilaginous plate on the plantar surface of the foot, the dorsal capsule and deep transverse metatarsal ligament on the dorsal surface, the flexor tendons on the lateral aspect and the lumbrical tendons on the medial aspect. Division of the fibrocartilaginous plate, the deep transverse ligament and the dorsal capsule facilitates reduction of dislocation.

Traumatic lesions of the metatarsophalangeal joint of the great toe in athletes

In the 1972, 1973, and 1974 football seasons at the University of Arkansas, 74 players sustained sprains of the ankle, producing a total of 152 missed practices and 6 missed games. Although only 18 injuries of the first metatarsophalangeal joint complex were seen, these later resulted in 92 missed practices and 7 missed games. This injury has been a significant problem for both the university and for most other major institutions, judging from a 70% response to 94 questionnaires sent to trainers of 94 large colleges and universities throughout the United States. It is the researchers opinion that the artificial turf surface, particularly as it ages, the shoes, and shoe fitting are all possible contributors to the incidence of the problem. Nonoperative treatment, whose hallmark is rest, is the treatment of first choice. Taping and splinting with a 0.51-mm spring steel splint with reinforcement, both pre- and postinjury, are beneficial. Injections of steroids or any other attempt to return the still painful athlete to activity are contraindicated. Late surgery, particularly in the event of capsular ruptures, as well as early repair, can be of benefit. The need to re-evaluate the shoes and playing surfaces in the light of this and other injuries is emphasized.

Lisfranc's tarsometatarsal fracture-dislocation

Lisfranc's fracture-dislocation is an injury at the tarsometatarsal joints. Usually the metatarsals dislocate dorsally and laterally. These frectures can be subtle, and a knowledge of the normal relationships is essential. Review of foot radiographs indicated that the most constant normal relationship of the tarsometatarsal joints is the alignment of the second tarsometatarsal joint, which, fortunately, is involved in most Lisfranc's dislocations. There is more variation in normal alignment of the other tarsometatarsal joints, but gross abnormalities are detectable, and the presence of associated chip fractures and clinical correlation will usually clarify more subtle cases.

[Injuries of Lisfranc's joint: severe sprains, dislocations, fractures. Study of 39 personal cases and biomechanical classification]

A study of 39 cases permitted us an analysis of the lesions of Lisfranc's joint, from severe fracture dislocation to fractures which are rarely reported in this joint. Standard XRay views seem to us insufficient and we propose carrying out oblique views and, sometimes, tomographic views. We were thus able to obtain information permitting a mechanical functional classification, and thus interpret the lesions in relation to the cause and thus adapt treatment. A long-term follow up of 23 cases suggests frequently invaliding sequelae after involvement of the tarso-metatarsal joints. The authors suggest resection and arthrodesis straightaway in dislocations.

Bilateral dorsal dislocations of the metatarsophalangeal joints of the great toes with a loose body in one of the metatarsophalangeal joints

An unusual bilateral closed dorsal dislocation of the metatarsophalangeal joints of both great toes is described, and surgical treatment and outcome reported. The importance of postreduction X-rays is emphasized.

Dorsal dislocation of the first metatarso-phalangeal joint. Report of four cases

The anatomy of the first metatarso-phalangeal joint and of dorsal dislocation of the phalanx are described. As similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury.

First metatarsophalangeal fusion in the salvage of failed hallux abducto valgus operations

The surgical technique of fusing the first metatarsophalangeal joint with multiple Herbert screws has been described. When properly performed, it can achieve a very high fusional rate and a relatively low incidence of complications. It is particularly useful in salvaging failed hallux abducto valgus operations, such as postoperative infection, angular and rotational deformities of the first metatarsophalangeal joint, complications of distal first metatarsal osteotomies, failure of the first metatarsophalangeal joint fusion, and iatrogenic destruction of the first metatarsophalangeal joint.