A Rare Case of Habitual Dislocation of the Fourth Metatarsophalangeal Joint

Dislocations of lesser metatarsophalangeal joints (MTPJs) following trauma, inflammatory arthritis, and synovitis are not uncommon. Closed reduction is sufficient in most instances. However, if it is not addressed scientifically in the first instance; rarely, a habitual dislocation may result.

We present a case of a 43-year-old male patient with painful habitual dorsal dislocation of the fourth MTPJ following a trivial trauma 2 years back, resulting in an inability to wear closed footwear. The patient was managed with the repair of the plantar plate, excision of the neuroma, and transfer of long flexor to dorsum to act as dynamic check rein. At 3 months, he was able to wear shoes and returned to normal activities. There was no radiographic evidence of arthritis or avascular necrosis at 2 years follow-up, and he was comfortably using closed footwear.

Isolated dislocation of the lesser MTPJs is an uncommon entity. Traditional practice is closed reduction. However, if the reduction is inadequate, open reduction should be performed to prevent chances of recurrence.