A dislocation is a joint injury in which the bones are forced out of their usual positions and are completely separated. Your joints are where two or more bones meet.
It can be hard to tell if a bone is broken or dislocated. It’s best to get medical help right away.
Symptoms of Toe Dislocation
The symptoms of a dislocated toe include:
- Looking out of place, bent, or distorted
- Swelling
- Bruising, which means there’s bleeding under your skin
- Trouble moving your toe
- Severe pain
If your bones are only partly out of position and not separated, it’s a subluxation.
You may have other injuries in addition to your dislocation. These include:
- Bones that are broken or cracked (fractures)
- Torn ligaments (sprains)
- Torn muscles
- Torn tendons, which connect your muscle and bone
A common big toe injury is called turf toe. This happens when the ligaments in your big toe joint are stretched or torn. The ligaments are tissues that hold your joints and bones together.
Turf toe is a painful injury and has similar symptoms to a dislocation, but it usually heals with rest and time. It got its name because of the artificial turf that football players often play on, but you don't have to be an athlete to get turf toe.
Your Toe Joints
With the exception of your big toe, your toes have three joints. These are:
- Metatarsophalangeal joint at the base of your toe
- Proximal interphalangeal joint in the middle of your toe
- Distal phalangeal joint, closest to the tip of your toe
The joints in your big toe are:
- Metatarsophalangeal joint
- Interphalangeal joint
A layer of cartilage covers the bones where they meet at the joints. The cartilage lets your bones glide smoothly when they move. A fibrous capsule encloses the joints. The inside of the capsule is lined with the synovium, or synovial membrane. It makes a fluid that lubricates your joints, called synovial fluid.
Causes of Toe Dislocation
Toe dislocation may happen because of:
- Direct force, such as from a fall or a motor vehicle accident
- Certain sports or activities, like running and dancing
- Repeated movements that cause wear and tear.
You may be at a higher risk for joint dislocations because of things like:
Your age. People over the age of 65 are more likely to have joint dislocations because they tend to fall more.
Some medical conditions. If you have certain conditions, dislocations may be more frequent. For instance, a rare hereditary disease called Ehlers-Danlos syndrome weakens your connective tissues and makes your joints loose. That makes them more likely to be dislocated or sprained.
Capsulitis of the second toe. Capsulitis is when the ligaments that surround the joint at the base of your second toe become inflamed. Without treatment, the inflammation can cause the surrounding ligaments to weaken and lead to dislocation of your toe. Capsulitis is more common in the second toe, but it can also affect the joints in your third and fourth toes.
Diagnosis of a Dislocated Toe
Your doctor will examine your injury. They’ll feel it to check whether the bones are out of place. They’ll look for swelling, bruising, and tenderness.
They'll order an X-ray of your toe. This will confirm the dislocation and whether you have any broken bones or other joint damage.
You might have an MRI scan or CT scan to look for damage to the soft tissues around your toe. But these usually are needed only in unusual cases.
Other tests may include:
- An angiography to check for damage to your blood vessels. This test uses a contrast agent that can be seen on X-rays.
- An electromyography to check for nerve damage.
Treatment for a Dislocated Toe
If you’ve injured your toe, seek medical help as soon as possible. This is important especially if your toe is at a different angle than the toe on your other foot and it wasn’t this way before your injury.
Without treatment, a dislocation can have a significant effect on how you walk and bear weight on your foot. There may also be long-term problems such as instability, pain, stiffness, and arthritis.
Until you can get treatment:
- Don’t move your injured toe. Hold it in place and support it with a pillow or a makeshift splint.
- Wrap some ice in a towel and put it on your toe to ease swelling and pain.
- Lie down and raise your foot, above your heart if possible, to limit swelling.
Dislocations can be realigned or reduced, which means they’re moved back into their regular position, without surgery. This is called a closed reduction. Your doctor may be able to pull or turn your toe. After that, they’ll take X-rays to check that the bones are back in their normal positions.
An open reduction is when you have surgery to move the dislocation. You may need it if your dislocation is severe or if a closed reduction doesn’t work, such as if the soft tissues are compressed by ligaments or other tissues.
Because realigning of bones can hurt, your doctor will probably give you medication to relieve the pain. It will depend on how severe your dislocation is and how the realignment will be done.
For a closed reduction, you’ll get a local anesthetic such as lidocaine to numb the area. For an open reduction, you’ll get a general anesthetic, which means you will be unconscious. An open reduction is done in an operating room.
After your toe joint is realigned, your doctor will use a foam-padded splint to hold it in place. You’ll probably need to wear it for 10 to 21 days.
After that, you may have buddy taping. This is when your dislocated toe is taped to the healthy one next to it. The healthy toe acts as a splint and holds the injured toe in place.
Your doctor will let you know when it’s safe to resume your activities and sports. If you return to sports too soon, you may risk re-injury.
Some people have long-term (chronic) dislocation of their joints. This may be because of things like an initial injury that was overlooked or a lack of treatment. That’s why it’s important to have any toe injuries checked by your doctor.