Dislocation of the First Metatarsophalangeal Joint: A Case Report and Suggested Classification System

Incarcerated Plantar Dislocation of the First Metatarsophalangeal Joint: Reduction Using Intra-articular Saline Injection

“…In contrast to the well-developed body of literature surrounding dorsal dislocation of the first MTP joint, [1][2][3][4][5][6] little is known regarding the pathomechanics and management of dislocation of the first MTP joint in the plantar direction. [7][8][9][10][11] A review of the literature reveals only four documented first MTP joint plantar dislocations.…”

“…Both of these acute closed dislocations were able to be reduced using simple closed manipulation with relative ease. 7,8 In 2017, Zrig et al 1 published an extensive review of the literature surrounding first MTP joint dislocation. Using this, the authors further refined the previously established classification systems for first MTP joint dislocation.…”

“…Keywords: dislocations; forefoot; toe; midfoot; trauma; big toe joint pain; sports injuries; sports podiatry T he vast majority of dislocations of the first metatarsophalangeal (MTP) joint are dorsal dislocations, and the pathomechanics of dorsal dislocation have been well described. [1][2][3][4][5][6] The mechanism is forced hyperdorsiflexion resulting in tearing of the plantar plate from its proximal attachment to the metatarsal neck. The plantar plate then follows the proximal phalanx, slipping dorsally over the metatarsal neck, and being held in this interposed position by the intact collateral ligaments.…”

“…Much less is known regarding dislocation of the MTP joint plantarly. 1 Indeed, only 2 acute closed plantar dislocations of the MTP joint have been reported, 7,8 and only one of these occurred in an otherwise healthy foot. 8 Because both were reduced by closed manipulation, a classification system developed by Zrig et al 1 in 2017 suggested that acute plantar dislocation of the first MTP joint should be reducible by simple closed manipulation.…”

Concomitant old complex fracture–dislocation of the first metatarsophalangeal, Lisfranc, and naviculocuneiform joints

“…3 Moreover, first metatarsophalangeal (MTP) joint dislocation is uncommon injury with dorsal, lateral, or plantar direction of dislocation. [4][5][6] Old first MTP, Lisfranc, or Chopart injuries could result in the functional loss with lifelong disabilities such as midfoot collapse, fixed deformity, pressure ulcer, arthrosis, and bothersome pain. Operative management of these injuries is fraught with several possible complications such as soft tissue coverage breakdown, wound dehiscence, infection, painful devices, iatrogenic injuries to adjacent joints and neurovascular bundles, and inability to achieve anatomic reduction.…”