A dislocation is a complete separation of the bones in a joint. Often, the ligaments that hold your bones together are torn. The bones of your toe can be dislocated by jamming your toe or by any injury that causes bending or twisting.
You'll feel sharp pain and experience swelling, and sometimes bruising. You may also hear a tearing or snapping noise. Your toe may look crooked or out of alignment.
A dislocated toe is a fairly common injury, especially in contact sports like football. It's also common in activities that involve jumping.
It's possible to have a dislocation and a chip or fracture of one of the bones of the toe at the same time.
Let’s look at the most likely symptoms you’ll experience if you’ve dislocated a toe.
Symptoms of a dislocated toe include:
- bruising and swelling
- crooked appearance
- pain or difficulty moving the toe
- severe pain (you may hear a snap or tearing sound)
- numbness or pins-and-needles feeling
In a pure dislocation, the bones are still intact, but they've moved out of their normal position at the joint. A subluxation is a partial dislocation, where the bones are out of position, but not completely separated.
A less severe type of injury is a sprained big toe, often called "turf toe.” This is still a serious and painful injury and can have a lot of the symptoms of a dislocation. But a sprain usually heals faster than a dislocation or a fracture.
At more risk
Any of your toes can become dislocated. But injury to the second toe is more common, according orthopedic surgeon A. Holly Johnson, MD, a board member of the American Orthopaedic Foot & Ankle Foundation.
People over 65 are more likely to dislocate a joint.
Children and athletes are at greater risk because of their stressful and riskier activity. But children recover faster than adults from dislocations, as with most injuries.
Diagnosis begins with a physical examination that may include gentle manipulation of the injured toe to feel for a dislocation or break. Your doctor may give you a pain reliever or muscle relaxant to make the examination less painful. Or they may inject a local anesthetic near the injured area.
If the joint feels unstable, it's a sign of possible dislocation.
If your doctor suspects a dislocation, they'll probably take an X-ray to confirm it. They'll also want to be sure there isn't an accompanying chip or fracture to the bone.
A CT scan may be done to see if small fractures are present. MRI imaging may also be done. However, these are usually unnecessary except in unusual cases.
Other tests your doctor may use include:
- an angiogram to see if there are damaged blood vessels; this is usually not necessary except in unusual cases
- nerve conduction studies to assess nerve damage; this might be done after the toe dislocation is reduced but rarely needed
To better understand your doctor's diagnosis, it's helpful to know the basic anatomy of the toes.
Each of your toes, except the big toe, has three bones known as phalanxes or phalanges. The big toe has only two large phalanxes. Dislocation occurs at one of the joints where the phalanx bones come together.
The three toe joints where dislocation can occur are:
- distal interphalangeal (DIP), or outer joint
- proximal interphalangeal (PIP), or middle joint (not present in big toe)
- metatarsophalangeal (MTP) joint, where your toe joins to your foot
If you have a painful toe injury, you should seek emergency care immediately. Don't wait to “see what happens.” Waiting can result in complications and permanent damage, especially as you continue to walk on or stay on your feet.
Things you can do before you can get to a doctor are:
- Prevent the toe from moving. Don't walk on a toe that may be dislocated.
- Lie down and prop your foot up so it's higher than your heart. This helps prevent swelling.
- Apply an ice pack or some ice wrapped in a towel to reduce pain and swelling. Keep this on for 10 to 20 minutes every hour for the first few hours, until you can get help.
These measures apply to people of all ages.
Pain relievers including aspirin, ibuprofen (Motrin, Advil), and acetaminophen (Tylenol) can help manage the pain. However, don’t take these medications until approved by your physician in case a general anesthetic may be used to reduce the dislocation. Don't use these pain relievers with young children, and follow appropriate dosing for older children.
The treatment for a dislocation is to reposition the bones into the proper alignment. This should always be done by a doctor or medical professional.
Realignment of the bones in a joint is known as reduction. There are two types of reduction: closed and open.
Closed reduction vs. open reduction
Closed reduction is when the bones are repositioned by external manipulation, without surgery. Dislocated toes can usually be treated with closed reduction, but sometimes an open reduction (surgery) is necessary.
Closed reduction can be painful, and your doctor may give you a sedative or inject a local anesthetic to help you manage.
Open reduction is a surgery done in the operating room. You'll be given general anesthesia by injection or a face mask.
In rare cases, the dislocated bones cannot be repositioned because of internal injuries. This is called an irreducible dislocation. It requires specialized surgery to deal with the additional internal injury.
After the reduction
Whether the reduction is closed or open:
- You'll be given a splint and possibly specialized footwear to keep the toe in alignment while the injury heals.
- The big toe may be wrapped with an elastic bandage to keep it in alignment, and may have a cast.
- You may also be given crutches to keep the weight off the injured toe.
Some people are able to return to regular activities within a day or two. For others, especially if the dislocation was in a big toe or is severe, it may take up to eight weeks to resume normal activity.
Keep these things in mind as you recover from a dislocation:
- Rest, icing, and elevation are your first steps to recovery.
- Don't immediately return to your usual level of activities.
- After time, your strength will return.
- Physical therapy and special exercises may be prescribed.
While your child recovers from a dislocated toe
- If their doctor put a removable splint on the toe, make sure your child wears it as prescribed. You may be told to remove it for sleeping and bathing.
- Have your child lie down and prop up their foot on a pillow when icing. This isn't effective while seated in a chair or couch. The foot must be higher than the heart so the fluids that cause swelling can drain.
- Make sure your child rests. This can be difficult, but explain that this is the way to get better faster.
- Help your child do any recommended exercises. Make sure you fully understand the instructions so you can supervise them.
A dislocated toe is a serious injury, and you can usually recognize it by the pain, swelling, and crooked appearance of the toe.
It can usually be straightened out (reduced) in a doctor's office without surgery.
Wearing proper footwear and avoiding unnecessary risk in sports and other activities can help prevent a toe dislocation.