• Hwee Weng Hey, Guohao Chang, Choon Chiet Hong, and Win Sen Kuan.
• Department of Orthopaedic Surgery, National University Health System, Singapore 119228, Singapore. hweeweng@gmail.com
• Am J Emerg Med. 2013 Jan 1;31(1):265.e1-3.

AbstractTraumatic dislocation of the metatarsophalangeal joint of an isolated lesser toe is an uncommon injury. We report a patient who presented 1 day after a dorsiflexion injury of the right foot. Physical examination showed a shortened and angulated right fourth toe resulting in scissoring of his digits. X-rays of the right foot confirmed complete dislocation of the fourth metatarsophalangeal joint. After failing 4 attempts at closed reduction, an orthopedic consult was made, and he underwent surgery. Six months after the operation, he developed avascular necrosis of the fourth metatarsal head. Reduction of the metatarsophalangeal of an isolated lesser toe is difficult due to the anatomical constraints imposed by the surrounding soft tissue. Failure at reduction after a single attempt by an experienced emergency physician should prompt the need for an orthopedic consult in view of likely surgery required. Avascular necrosis of the metatarsal head can also occur as a late complication after such injury.

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