Predislocation Syndrome Treatment

Predislocation Syndrome Treatment

Causes of Pre-dislocation syndrome:

  • Most commonly a bunion forms and causes upward dislocation of the 2nd toe.
  • This can frequently be due to shoe pressure.
  • A shoe cause a bunion to form and cause the 2nd toe to move upward.
What causes a bunion?
Although this is difficult to prove, tight shoe gear has shown that those genetically susceptible to bunion formation are more likely to form a bunion.

 

Anatomy of Pre-dislocation Syndrome:

  • The ligament that holds the 2nd toe down is called the plantar plate.
  • As time goes on this ligament can simply elongate ad rupture.
The plantar plate is the ligament that does elongate and eventually rupture.

 

Conservative  Pre-dislocation Syndrome Treatment:

  • Stabilize the joint with tape- perform a figure eight loop around the top of the base of the toe that looks like one of those support the troops ribbons(do this with tape). Use half inch cloth tape, or even duct tape works (just split it down the middle).
  • You can also get yourself an over the counter hammertoe splint to brace the toe properly.
  • Cut out some felt in a U shape around the bottom of the big toe to offload the metatarsal phalangeal joint. Any cutout in felt that offloads the peak pressure area will work in reducing further pain and inflammation and give the plantar plate a chance to heal.
  • Perform icing, elevation and take a two week course of anti-inflammatory medication to start too cool down the swelling in the digit. These treatments are not just to control to the pain, but to reduce the swelling which will lead to faster healing times.
  • Calf, plantar fascia and ankle stretching is essential to the healing process.
This is what can eventually lead to crossover toe

Shoe gear for Pre-dislocation Syndrome

  • This is essential! Your footwear is very heavily tied into why you developed the problem in the first place. If poor or not perfect footwear choices are not the cause, then they are at least heavily contributing to the problem.
  • Avoid walking in poorly supported shoes like sandals, moccasins or flats. It is also a good idea to get rid of high heels if you are a lady (I know, I know- I tried!)
  • Get yourself some stiff soled shoes- running shoes work best in this case. Make sure you use a Brannock device to measure the foot width, foot length and arch length of your shoe. Get some help from your Podiatrist in measuring your shoe gear.

 

This is a true toe dislocation, in this case the pinky toe.

Predislocation Syndrome Surgery:

 

This is a crossover toe with a corn on top of the toe.

This line of conservative therapy should be attempted for at least a good two to six months to give the plantar plate a chance to heal. If it does not – then you should move onto injection therapy to attempt to resolve the inflammation in the joint.

 

This toe was so dislocated that sometimes the best solution and pain relief is to just remove the toe.

The danger with a cortisone shot is that while it will remove the pain initially and start decreasing the inflammation which is essential to healing, it will on the other hand weaken the already damaged ligaments and tendons in the area.

-The injection of cortisone and dexamethasone phosphate should be injected from the plantar aspect (this is where the plantar plate tear is located). Injecting into the MTPJ will likely not be effective as this is not the primary site of inflammation. It is essential that the patient keep the toe well protected with tape, padding, orthotics, shoe wear, icing and stretching. The tendon will be susceptible to further damage at this point. There is a real chance of rupture of the plantar plate occurring so this should not be taken lightly.

-Injection therapy is the last choice before surgery must be considered.

 

For more on Pre-dislocation Syndrome Treatment:

http://www.podiatrytoday.com/article/6822