Traumatic dislocations of the lesser toes.

Abstract

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.