TOE DISLOCATION |
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General Information
DEFINITION--Injury to any toe joint so that adjoining bones are displaced from their normal position and no longer touch each other. Fractures and ligament sprains frequently accompany this dislocation. Toe dislocations are a common problem for athletes.
BODY PARTS INVOLVED
Bones of the toes.
Ligaments that hold toe bones in place.
Soft tissue surrounding the dislocation site, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Excruciating pain in the toe at the time of injury.
Walking difficulty.
Severe pain when attempting to move the injured toe.
Visible deformity if the dislocated toe has locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis beyond the dislocation from pinching, cutting or pressure on blood vessels or nerves.
CAUSES
Direct or indirect blow to the foot.
End result of a severe toe sprain.
Congenital abnormality, such as a shallow or malformed joint surface.
RISK INCREASES WITH
Contact or collision sports, especially those that require cleated shoes.
Previous foot or toe dislocation or sprain.
Repeated injury to any part of the foot.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning in the foot.
HOW TO PREVENTWear appropriate, well-designed shoes during competition or other athletic activity. Tape the toes to prevent reinjury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manipulation of the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the foot and ankle.
POSSIBLE COMPLICATIONS
Pressure or damage to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissue.
Excessive internal bleeding in the toe.
Impaired blood supply to the dislocated area.
Death of bone cells due to interruption of the blood supply.
Infection introduced during surgical treatment.
Continuing recurrent dislocations, often with progressively less severe provocation.
Prolonged healing if activity is resumed too soon.
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the foot may require immobilization with a splint, taping or special shoe for 2 to 3 weeks. Injured ligaments require a minimum of 6 weeks to heal.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will manipulate the dislocated toes to return them to their normal position. Manipulation should be accomplished within 6 hours, if possible. After that time, many tissues lose their elasticity and become difficult to return to a normal functional position.
CONTINUING CARE
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
You may apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured foot with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling. Stroke from the toes toward the heart.
Have a metatarsal bar sewed into your shoe by a shoe repairman or brace-maker.
MEDICATIONYour doctor may prescribe:
Local anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen or aspirin to relieve moderate pain, and narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
ACTIVITYResume normal activity when comfortable.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when pain subsides.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated toe, especially if the toe becomes numb, pale or cold. This is an emergency!
Any of the following occur after treatment or surgery:
Swelling above or below the cast.
Blue or gray skin color, particularly under the toenails.
Numbness or complete loss of feeling below the dislocation.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Toe dislocations that you can "pop" back into normal position occur repeatedly.
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