Lesser Toe MTP Joint Dislocation: The Jahss Maneuver and Management

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Lesser toe metatarsophalangeal (MTP) joint dislocation — dorsal displacement of the proximal phalanx over the metatarsal head — is a painful injury that typically occurs from axial loading with hyperextension of the toe (stubbing, catching the toe, or athletic injuries) and may be irreducible by standard traction techniques when the plantar plate and flexor tendons become interposed between the metatarsal head and proximal phalanx. The Jahss maneuver is the specific reduction technique that addresses this interposition, and understanding its rationale is important for managing this injury without unnecessary surgical intervention.

Mechanism and Irreducibility

Normal MTP joint stability: the plantar plate — the fibrocartilaginous structure on the plantar surface of the MTP joint — is continuous with the flexor tendon sheath and the collateral ligaments; the plantar plate keeps the toe aligned with the metatarsal head and prevents dorsal hyperextension. Dislocation mechanism: forceful hyperextension dorsally displaces the proximal phalanx, tearing the plantar plate from its metatarsal head attachment and exposing the metatarsal head plantarward; the flexor tendons and plantar plate can become wrapped around the metatarsal neck (the ‘buttonhole’ mechanism), creating an irreducible dislocation where longitudinal traction only tightens the interposition. Clinical recognition: the toe is displaced dorsally with the MTP joint in hyperextension; the metatarsal head creates a palpable and sometimes visible plantar prominence; traction attempts may feel springy without reduction (the buttonhole effect). Second MTP joint is most commonly involved.

The Jahss Maneuver

Technique: (1) flex the MTP joint as far as possible (this slackens the plantar structures, allowing disengagement of the metatarsal head from the buttonhole); (2) apply distal traction along the axis of the toe while maintaining MTP flexion; (3) plantarflex the proximal phalanx to reduce the dorsal displacement. The key principle is that MTP flexion — not extension — allows the plantar plate and flexor tendons to disengage from around the metatarsal neck. After successful reduction: X-ray confirms reduction; buddy tape the affected toe to adjacent toes for 4–6 weeks; stiff-soled shoe to reduce MTP motion; return to activity at 6–8 weeks. Irreducible dislocation requiring surgery: if closed reduction under adequate anesthesia fails after two attempts, surgical reduction through a dorsal approach with plantar plate release is required. Dr. Biernacki at Balance Foot & Ankle manages lesser toe MTP joint dislocations with closed reduction under digital block anesthesia, using the Jahss maneuver for irreducible dislocations, and performs surgical reduction when necessary. Call (810) 206-1402 at our Bloomfield Hills or Howell office for acute toe injury evaluation.

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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care