Dislocations

Discussion:

  • Turf toe is a tear of the joint capsule from the MT head which results in subluxation or dislocation of the first MTP joint.
  • Caused by hyperextension (most common), hyperflexion or valgus injury.
  • Associated with decreased ROM at first MTP joint and its sequele can include hallux rigidus and can exacerbate sesamoiditis.
  • Turf toe can be an extremely debilitating injury in competitive football players.

Radiographs:

  • With dislocation of the MTP joint without sesamoid fracture, anticipate difficulty with closed reduction.

Treatment of Hyper-extension Injuries:

  • Activities are reduced for 3 weeks, and afterwards the patient must wear an orthosis that blocks dorsiflexion during atheletic activities.

Dislocations:

  • Dislocations of hallux MTP joint are classified based on x-ray appearance of the sesamoids.

Type I:

  • Plantar plate ruptures at its proximal attachment to metatarsal neck and dislocates with attached sesamoids riding over the metatarsal head.
  • Plantar plate-sesamoid complex follows the proximal phalanx.
  • Metatarsal head can buttonhole into the plantar capsule which prevents closed reduction.
  • Disruption of volar plate - sesamoid complex.
  • No sesamoid fracture.
  • No widening of inter-sesamoid space.
  • Reduction is blocked by the interposed volar plate.
  • Open reduction is performed through dorsal approach.  

Type II:

  • Widening of inter-sesamoid interval.
  • Closed reduction is usually possible.

Type II:

  • Transverse fracture through the sesamoids.
  • Closed reduction is usually possible.