By Amelia Son, PTA, Site Coordinator
Overview of Toe Injuries
Toe dislocations are quite common and usually occur in contact sports or when jumping is involved. On occasion, an injury to the big toe called “turf toe” can have the same signs and symptoms as a toe dislocation, but is less severe and heals faster. While any of your toes can be dislocated, second toe dislocations are the most common. Due to stressful activity and often riskier activities, children and athletes are more likely to experience toe dislocations. People over the age of 65 are also at a higher risk of dislocations and do take longer to recover than children. The following will discuss signs and symptoms of toe dislocations, how it is diagnosed, and how it is taken care of by a medical professional.
Anatomy of the Toe
Before the signs and symptoms are discussed, it is best to know the anatomy of the toes. Each toe has 3 parts called phalanges, except your big toe, which only has two. Dislocations occur at the joint where the phalanges join. The three joints are named for there location in relation to your foot and are as follows:
- Distal interphalangeal joint, AKA DIP, the outermost joint
- Proximal interphalangeal joint, AKA PIP, the middle joint – not in big toe
- Metatarsophalangeal joint, AKA MTP, where the toe meets the foot
Signs and Symptoms of a Toe Subluxation and Dislocation
A dislocation can occur at any of these joints in the foot with the proper injury. There are two types of dislocations called a pure dislocation and a subluxation. A pure dislocation is when all the bones are still intact by they are not in their normal anatomical position. A subluxation is considered a partial dislocation and while the bones are out of position, they are not completely separated. Signs and symptoms of a dislocation are as follows:
- A crooked appearance of the toe
- Bruising and swelling in the area
- Pain with moving the toe – or difficulty moving the toe
- Numbness in the area
- Severe pain in the toe
Diagnosis and Treatment
Diagnosing a dislocated toe is simple and begins with an exam of the toe. Your physician may do gentle movements to feel for a dislocation or a break. They will decide if the joint feels unstable and will then do an x-ray to confirm and make sure there are no other issues like a broken bone. While it is usually not necessary for a toe, they may order an angiogram to make sure there is no damage to blood vessels. If the MD does diagnose the toe as dislocated there are two options for repositioning the joint. They are called closed or open reduction and are described below;
- Closed reduction: The joint is repositioned without surgery. This is can be done in the office and the MD may give an injection for pain.
- Open reduction: The joint is repositioned with surgery in the operating room.
After either reduction, some sort of splint or footwear will be given to the patient to keep the toe aligned and avoid further injury. Often times, the MD will suggest using crutches to keep weight off the injured toe as well.
Recovery after reduction is simple and often times fast. Most people can get back to their normal activities of daily living within a week. However, it may be up to 8 weeks of recovery time if the dislocation was more severe and there were broken bones.