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  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section


Khairul Faizi Mohammad, Brad Yoo

Executive Editors

Markku T Nousiainen, Richard Buckley

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Closed/open reduction with taping or rigid-soled shoe

1. Timing of surgery

The timing of surgery is influenced by the soft tissue injury and the patient's physiologic status.

Dislocation or injuries associated with the skin at risk requires immediate intervention regardless of the amount of soft tissue swelling.

2. Closed reduction

Dorsal dislocation is most common due to the hyper-extension mechanism.

The reduction should be performed expeditiously under local anesthesia (digital block).

Impingement of the proximal phalanx base with the dorsal metatarsal neck may prevent spontaneous reduction.

The plantar plate and collateral ligaments may block reduction.

Dimpling may signify a complex dislocation where closed reduction may not be successful.

The proximal phalanx is extended, and traction is applied to free the inferior rim from its impingement on the metatarsal's dorsal surface.

Reduction of MTP dislocation

The toe is then translated in a plantar direction.

The MTP joint must be immobilized in an anatomical position to avoid a dorsiflexion contracture.

If the reduction is stable, K-wire fixation is not required, and alignment can be maintained by buddy taping.

 Reduced MTP dislocation

Pitfall: interposition of the plantar plate

The plantar plate detaches from the metatarsal neck and may become incarcerated within the joint. Irreducible dislocations are more common when the intersesamoidal complex is intact, demonstrated by the lack of divergence between the sesamoids (on an AP radiograph - see case below).
A dorsal incision will allow visualization of the joint and identification of incarcerated tissue.
The joint reduction is performed readily once the obstructing tissue is released.
The interposition of the plantar plate

3. Buddy taping

The skin is cleaned, and 5–10 mm wide straps are fixed in a loop around the toes. Gauze may be placed between the toes to avoid maceration of the skin.

orif screw fixation

4. Aftercare

A stiff-soled orthosis, like a flat, rigid sole shoe, is used to protect the reduction and allow healing.

The symptoms usually settle over the first few weeks. The tape should be changed frequently to prevent maceration between the toes. Most patients are capable of doing this themselves.

Taping can be discontinued after 4–5 weeks.

Rigid sole shoe

5. Case

This case is a complex MTP dislocation with interposed soft tissues, making a closed reduction impossible.

AP and oblique view before open reduction

k wire fixation

Lateral view before reduction

k wire fixation

Lateral view following a succesful open reduction

k wire fixation

AP view showing the result of a successful open reduction

AP view showing the result of a successful open reduction