Traumatic horizontal deviation of the second toe: mechanism of deformity, diagnosis, and treatment

Two patients with a deviated overlapping second toe due to rupture of the dorsal lateral metatarsophalangeal (MTP) collateral ligament and the lateral interosseous tendon were diagnosed, analyzed, and treated. Athletic activities were responsible for the tendon-ligament ruptures and the ensuing medial deviation of the second toe. Pain occurred in the second MTP joint, and a dorsal corn formed over the proximal interphalangeal joint (PIP). Reconstructive procedures included lengthening of the interosseous-lumbrical tendons and the collateral ligament on the medial side of the joint; a dorsal capsule incision; repair of the lateral collateral ligament and interosseous tendon; transfer of the flexor digitorum longus to the extensor digitorum longus; and shortening of the proximal phalanx in one patient. These soft tissue reconstructive procedures and realignment joint congruity are essential to relieve pain and prevent traumatic arthrosis. The treatment completed on the two patients resulted in relief of pain, satisfactory function, and alignment of the digits involved.