MANUAL MINORS
Toe dislocations occur when the bones of the toes are forced out of their normal alignment at the joint, typically due to direct trauma or twisting. The most commonly affected joints are the metatarsophalangeal joints (at the base of the toe) or the interphalangeal joints (between the toe bones). These dislocations can be painful and cause visible deformity, limiting the ability to walk.
Diagnosis
Diagnosis is based on a history of trauma or sudden movement, followed by sharp pain, swelling, and deformity in the affected toe. The toe may appear out of its normal position. Mobility is limited, and the patient often experiences intense pain when attempting to move or touch the toe. X-rays confirm the diagnosis, showing the displacement of joint surfaces and ruling out associated fractures.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Toe fracture | Similar pain, but with bone breakage rather than joint displacement. |
Toe sprain | Ligament injury with pain and swelling but no visible displacement. |
Toe contusion | Pain and swelling after a blow, but no dislocation or displacement. |
Traumatic arthritis | Chronic pain and stiffness in the joint, without an acute dislocation event. |
Emergency Management
Emergency management includes closed reduction of the dislocation, which involves manipulating the toe to return the bones to their anatomical position under local anaesthesia or sedation.
After reduction, the toe is immobilised with “buddy taping” (taping it to the adjacent toe) or a temporary splint, depending on the severity of the injury. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are administered to control pain and inflammation.
Definitive Treatment
After reduction, the definitive treatment involves keeping the toe immobilised for 2 to 3 weeks to allow soft tissue healing. Rest is recommended, avoiding activities that place pressure on the foot.
In cases of recurrent or unstable dislocations, surgical intervention may be necessary to repair damaged ligaments or stabilise the joint. Post-reduction rehabilitation includes mobility and strengthening exercises to restore full toe function.
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