First metatarsophalangeal joint dislocation: uncommon affection

¹Orthopedic Trauma Service I, Military Training Hospital Mohamed V, Rabat, Morocco

^&Corresponding author
Ayoub Bouya, Orthopedic Trauma Service I, Military Training Hospital Mohamed V, Rabat, Morocco

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A 40-year-old man, builder, non-smoking, right-handed, without medical history, consulting in the emergency room for a right foot trauma. The mechanism was a hyperextension of the great toe secondary to a fall from 2 meters. Physical examination found a deformed and swollen great toe. The axis of the hallux was altered to hyperextension. Motion attempts were painful. The patient couldn´t walk without lameness. Cutaneous and nervous examination was normal and capillary refill time was less than 2 seconds. X-rays showed dislocation of the hallux. The first phalanx moved dorsally without osseous lesions (A,B). Four hours after the trauma and under moderate anesthesia, the dislocated metatarsophalangeal joint was reduced. Radiological control was satisfying (C,D). The first metatarsophalangeal joint was protected by a temporary syndactylization of the second and first toes for 4 weeks. The patient was able to walk with Barouk shoe and an English cane. After 4 weeks, the patient practiced passive motion of the great toe. At 3 months follow up, the patient was able to walk normally. The active motion of the great toe was possible without restriction or pain.

Figure 1: first metatarsophalangeal joint dislocation