A Rare Case of Neglected Fifth Metatarsophalangeal Joint Dislocation

Abstract

The dislocation of the metatarsophalangeal joint of lesser toes is a rare entity. There is a dearth of literature on the same. Also, there is no case described for neglected fifth metatarsophalangeal dislocation in the literature. We present a case of neglected lesser toe dislocation, its natural course, and its outcome after surgical management. Our patient is an eight-year-old child with a neglected dislocation of the fifth metatarsophalangeal joint two years back. The patient did not seek treatment because he has no problem walking. Gradually, there is an abnormal growth of the metatarsal which causes pressure soreness and difficulty walking. The patient was managed surgically with open reduction and K-wire fixation with good long-term results. The dislocation of fifth metatarsophalangeal dislocation is rare and may not cause difficulty in walking due to less weight-bearing. But prompt treatment is necessary, especially in children as the bones have remaining growth potential and may lead to abnormal bone growth.

Keywords: dislocation; foot; lesser toe; metatarsophalangeal joint; neglected.

Figure 1. Pre-operative (at the time of presentation, two years after injury) x-ray showing dislocation of the fifth metatarsophalangeal joint

Figure 2. Clinical photograph showing callosity at plantar aspect of foot

Figure 3. Dorsal incision showing distal end of fifth metatarsal with bone growth at epiphysis

Figure 4. Immediate post-operative x-ray with k-wire

Figure 5. X-ray after two years of follow-up with maintained reduction