What is a dislocated toe?
A dislocated toe is the medical term used when the ligaments of the toe (phalanges) have been injured by being overstretched or torn to the extent that the two connecting bones have become dislodged and are no longer aligned as they should be. The foot itself is made up of three sections of different bones. The bones at the back of the foot under the ankle joint are known as the tarsal bones which include the calcaneus (which forms your heel), the talus (which forms part of the ankle), navicular, cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the five long metatarsal bones. The metatarsals connect at the back to the cuneiforms and cuboid bones and at the front to the toes. The toes are the last section consisting of five bones numbered in the sense that your big toe is first and your little toe is your fifth. The toes are called phalanges which like the fingers are individually divided into three parts; there is a distal section (the section under your nail), a middle section and a proximal section (the section that connects to the metatarsals), the big toe is referred to as the hallux.
The three joints of a toe are made up of strong capsules that form around each joint, enclosing it and preventing either boney ends of the interconnecting bones from impacting. The first joint is known as the metatarsal-phalangeal joint (the joint that connects the metatarsals to the phalanges), the second joint that connects the proximal phalangeal bone to the middle phalangeal bone is called the proximal interphalangeal joint (pip joint) and the last joint is the distal interphalangeal joint (dip joint) connecting the distal and middle bones. The big toe differs from the rest in only having two interconnecting joints, it is missing the proximal interphalangeal joint. The formation of the joints allows a wide range of movement in flexion and extension and also allows you to curl your toes. Each joint capsule is filled with a small amount of thick fluid called synovial fluid which acts as a cushion. There is protective layer of articular cartilage that covers each boney surface. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments that surround the joint are made of thick, tough, fibrous tissue; they overlap the joint and work in co-ordination with the attaching muscles to provide protection and stability for the toe.
Why and when does a dislocated toe happen?
Dislocation of one of the toe joints is a relatively common injury and can affect people of all ages. It is normally the result of severe impact, such as kicking something awkwardly or a hard object. It can be a common injury during sports like football during tackles when a player kicks an opponent’s boot or from dancing and awkwardly landing on the toe. Although any activity of high impact where the toe hyper-flexes or hyper-extends into an abnormal position with your body weight behind it can result in a dislocated toe. A dislocation injury is very similar to a grade 3 sprain but the trauma sustained is normally a much greater force than that of a sprain. There are some risk factors that may leave you more prone to suffering from a dislocated toe, such as wearing inappropriate footwear that doesn’t support or protect the toes.
What does a dislocated toe feel like?
A dislocated toe causes an intense, immediate, sharp pain around the dislocated joint, the pain can radiate up into the front of the foot, down into the sole of the foot and occasionally into the ankle. In some cases a tearing or snapping noise is heard during the injury. The dislocation will be accompanied by intense swelling and bruising and will be incredibly tender to touch. There will be visible joint deformity with the far end of the joint hanging limply. Pain levels will be aggravated by any toe movements making weight bearing and walking on the affected toe very painful. In cases where the dislocation is resolved quickly patients can still fully use their toes with only slight stiffness and a feeling of discomfort on weight bearing resulting in a very mild limp. The intense pain that some patients experience from a dislocation will last until the joints are reset and will be aggravated or prolonged by any walking or examination.
What to do if a dislocated toe is suspected?
Your actions immediately after a dislocation can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol; this involves Protection for the toe by either strapping it or using an elastic bandage like a tubi-grip. Rest your foot, try not to walk on it too much and if you have to then ensure you are wearing shoes that aren’t too tight over the toes but which still provide the toes with protection. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the ice pack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and ensure you take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
You should seek medical attention straight away in order to have the joint reset to its proper alignment; your doctor will most likely splint your toe to the one next to it in order to provide it with support whilst it heals. It is advisable to follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days, after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating movements should be avoided in case of further injury. Massage should be avoided for the first three days after injury as it will also increase any bleeding and swelling.
How long does a dislocated toe take to heal?
A dislocated toe can recover in as little as one to two weeks if reset quickly, more moderate or severe dislocations take longer, however most dislocations have fully healed within six weeks. The after effect of a dislocated joint is that the joint is lax and more prone to injury and you may feel it is always on the point of dislocating even after minor knocks. Recurrent dislocations of the same joint may require surgical intervention although this is rare for the toe and more commonly used in ankle dislocations.
How will a dislocated toe be diagnosed?
Your GP or Therapist will be able to diagnose you by both listening to your history and examining you. Your GP may refer you for X-rays or further investigation to rule out the presence of any fractures or other complications.
What treatment options are available for a dislocated toe?
Your GP will most likely prescribe anti-inflammatory medication to reduce any swelling and painkillers for pain relief. You will be initially advised to follow the P.R.I.C.E and H.A.R.M protocols outlined above. A dislocated ankle would normally be dealt with by an orthopedic specialist due to the risk of damaging the surrounding arteries or nerves. However, due to the smaller risk with a toe your doctor may be able to reset the joints in clinic without referring you to a specialist. After the joints are manipulated and reset a splint will normally be applied where the affected toe is tethered to the next toe to stabilise and protect it whilst it heals. A dislocated toe can take anything from 4-6 weeks to heal, if not longer in more severe cases. Your GP or therapist should be able to provide you with exercises to strengthen your foot and toe to aid the healing process and prevent reoccurring injury. Many people find manipulative therapies such as physiotherapy, chiropractic and osteopathy helpful in restoring function to the surrounding joints and providing strengthening exercises. The ice packs used initially will be very helpful during the recovery process when the toe swells after long periods of walking, early in the morning or late in the evening.