MANUAL MINORS
Metatarsal dislocations occur when one or more metatarsals shift from their anatomical position in the tarsometatarsal or metatarsophalangeal joints. The most common dislocation in this region is Lisfranc, which affects the tarsometatarsal joints and is typically associated with high-energy trauma, such as falls from height or motor vehicle accidents, although it can also occur in contact sports. These dislocations are serious injuries that require urgent treatment to avoid long-term complications.
Diagnosis
Diagnosis is based on a history of trauma, followed by intense pain, swelling, visible deformity in the midfoot, and difficulty walking or bearing weight. Palpation may reveal a point of maximal tenderness over the affected joint.
It is confirmed with anteroposterior, lateral, and oblique X-rays of the foot, though computed tomography (CT) is useful in complex cases or when X-rays are normal but clinical suspicion persists.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Lisfranc fracture | May be associated with dislocation, with bone fragments visible on X-ray. |
Metatarsal fracture | Shows a clear bone break, rather than joint displacement. |
Foot sprain | Less severe, with pain and swelling but no evident bone or joint displacement. |
Foot contusion | Pain and swelling without radiographic signs of dislocation or fracture. |
Emergency Management
In the emergency setting, immediate management includes closed reduction under sedation or local anaesthesia to restore the alignment of the metatarsals. Following reduction, the foot is immobilised with a posterior splint or orthopaedic boot, and follow-up X-rays are ordered. Pain is managed with analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), and weight-bearing is avoided using crutches.
Definitive Treatment
If the dislocation is stable after reduction, treatment involves immobilisation and non-weight-bearing for 6-8 weeks. In cases where the dislocation is unstable or associated with fractures, surgery is required for internal fixation with plates or screws. Physical rehabilitation is crucial to restore mobility and prevent complications such as post-traumatic osteoarthritis or chronic foot instability.
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