Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation

Abstract

Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe.

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

“…Traumatic dislocations of the first toe are common, but lesser toe joint dislocations are rare injuries that have only been mentioned in case reports [1][2][3][4][5][7][8][9][10][11][12][13][14][15] . Most dislocations are dorsal and caused by a dorsiflexion force in hyperextended toes 1,2 while direct pressure on the metatarsal head from the plantar direction may lead to plantar dislocation [3][4][5] . Transversely directed forces may lead to medial or lateral dislocations 8,9 .…”

“…Persistent dislocation leading to avascular necrosis (AVN) has been noted in the hip joint for pediatric patients 11 , and we suspect that similar changes may occur in the dislocated metatarsal head, leading to irreversible joint damage. Reports of the plantar capsule 10,12 , deep transverse ligament 12,13 , plantar plate 10,15 , collateral ligaments, and long tendons 2,3 hindering MTP joint reduction have been previously reported.…”

“…Dislocation of the lesser toes is less commonly reported, and its incidence is unknown because of its rarity. Most MTP dislocations are hyperextension injuries 1,2 , but plantar flexion injuries have also been reported [3][4][5] . When neglected, these injuries can cause foot pain and deformity.…”