Plantar dislocation of the metatarsophalangeal joint: case report

Neglected Metatarsophalangeal Joint Dislocation of the Lesser Toe with Associated Metatarsal Fracture Malunion in a 4-Year-Old Child: A Case Report

CASE

A 4-year-old girl presented with a 5-week-old, neglected fourth metatarsophalangeal (MTP) joint dislocation with malunion of the fourth metatarsal. A previous attempt at closed reduction had failed. The reduction was hindered by dynamic stabilizing of soft tissues around the MTP joint. Open reduction of the fourth MTP joint dislocation and corrective osteotomy of the fourth metatarsal was performed. The patient was pain-free without any cosmetic deformity at the 1-year follow-up.

CONCLUSION

Prompt recognition of a MTP dislocation is vital. The long extensor tendon to the toe can hinder the closed reduction of the MTP dislocation. Osteotomy of the metatarsal malunion is necessary for stable reduction.

LEVEL OF EVIDENCE

4.

A Rare Case of Neglected Fifth Metatarsophalangeal Joint Dislocation

The dislocation of the metatarsophalangeal joint of lesser toes is a rare entity. There is a dearth of literature on the same. Also, there is no case described for neglected fifth metatarsophalangeal dislocation in the literature. We present a case of neglected lesser toe dislocation, its natural course, and its outcome after surgical management. Our patient is an eight-year-old child with a neglected dislocation of the fifth metatarsophalangeal joint two years back. The patient did not seek treatment because he has no problem walking. Gradually, there is an abnormal growth of the metatarsal which causes pressure soreness and difficulty walking. The patient was managed surgically with open reduction and K-wire fixation with good long-term results.

The dislocation of fifth metatarsophalangeal dislocation is rare and may not cause difficulty in walking due to less weight-bearing. But prompt treatment is necessary, especially in children as the bones have remaining growth potential and may lead to abnormal bone growth.

Irreducible metatarsophalangeal joint dislocation of the lesser toes: a case report

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation.

Stability of the metatarsophalangeal joint of the lesser toes: a cadaveric study

Dorsal instability of the metatarsophalangeal joint (MTPJ) of the lesser toes is an important cause of forefoot pain. Both conservative and surgical treatment options have been proposed. However, the role of each static stabilizing structure has not been elucidated. We hypothesized that isolated sectioning of the plantar plate (PP) would result in greater dorsal translation compared to isolated sectioning of the medial collateral ligaments (MCL) or lateral (LCL) collateral ligaments, or the extensor hood (EH), and that combined injury to two or more structures would result in greater dorsal translation compared to isolated PP injury. Fifty-four cadaveric lesser toe specimens were randomized into groups for individual and combined sectioning of the PP, EH, and LCL and MCL. A 30 N axial load was applied to each specimen in the plantar-dorsal direction and dorsal translation of the phalanx was measured for each condition. ANOVA was used to compare groups. A 19% change in MTP translation was found from intact after sectioning the PP. No significant difference in translation was seen after individual sectioning of the EH, MCL, or LCL. A significant increase in translation occurred from intact with the following sectioning combinations: MCL + LCL, 37%; EH + MCL + LCL, 45%; and PP + MCL + LCL, 63%. Thus, the PP is the main restraint for dorsal MTPJ translation. MCL and LCL have important partial contribution to MTPJ stability. Injury to the PP, individually, or combined injuries to the PP, EH, MCL, or LCL, appear to cause significant instability that may warrant more aggressive treatment.

Irreducible dorsal metatarsophalangeal joint dislocation of the fifth toe: a case report

The authors report a case of a dorsal dislocation of the fifth metatarsophalangeal joint that could not be reduced by closed manipulation, and instead required open reduction with Kirschner-wire fixation to maintain alignment. Although metatarsophalangeal joint dislocation is not unheard of, it is not common for the deformity to resist efforts at closed reduction and immobilization or percutaneous pin fixation. One year after surgery, the patient described in this article had returned to his baseline activity level, and was ambulating without pain while demonstrating full range of motion in the fifth metatarsophalangeal joint.

Fracture-dislocation of the second metatarsophalangeal joint: a case report

Traumatic second metatarsophalangeal dislocation is extremely rare. This article reports a case of traumatic second metatarsophalangeal dislocation associated with fracture of the second metatarsal shaft. Anatomical reduction is indispensable to preserve the function of the metatarsophalangeal joint and to avoid joint ankylosis and chronic foot pain. The patient was treated with open reduction of the fracture without violating the joint to decrease postoperative stiffness. He was followed-up for 6 months. The patient resumed full activity 3 months after surgery, with his joint attaining full range of movement. He reported no pain or joint stiffness during his last visit. To our knowledge, no similar injury has been reported previously.

Injuries to the toes and metatarsals

Traumatic injuries to the toes and metatarsals are common injuries affecting nearly every individual. Injuries may be precipitated by industrial accidents or simple bumps in the night. They can produce a wide spectrum of consequences ranging from permanent disability to asymptomatic deformities. With appropriate treatment, most individuals should have the capacity to return to their preinjury functional status.

Traumatic dislocations of the lesser toes

Traumatic dislocations of lesser metatarsophalangeal joints (DLMTPJ) and lesser interphalangeal joints (DLIPJ) are very uncommon. A retrospective analysis of 31 cases and of the 16 reported cases was conducted to clarify our understanding of the pathomechanics, the role of associated injuries, recommended treatment, and outcome. Hyperextension with axial loading produces the injuries. Ipsilateral foot fractures or dislocations often occur and thus may compromise the outcome. Thirty percent of DLMTPJ and virtually all DLIPJ require open reduction; most often, the plantar plate prevents closed treatment of either DLMTPJ or DLIPJ. At follow-up, treated isolated DLMTPJ have few or no complaints; disability persists in patients who suffered concomitant displaced ipsilateral midfoot or forefoot fractures or dislocations. Neglected DLMTPJ remain symptomatic. All reduced DLIPJ are pain free.