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Dislocated Big Toe, prone to re-occur

Hi, I am a 59 year old female who has a long history of foot problems, surgeries. My Right foot was broken, Jones Fracture, Comminuted fracture of 5'th Metatarsal in 2001, took 7 months to heal, After that has failed bunionectomy, Hallux varus, attempted joint salvage, failed again, last resort was Fusion of rt foot with titanium plate, 5 screws and also removal of both sesmoids. On Dec.14th, fell off front porch steps , severe instant pain, swellings and bruising.
Dec. 15th, had Xray of foot that showed severe dislocation first Metarsal rt foot, with ruptured, torn tendons, ligaments, nohing attached. Had reduction done on 17th in Surgeon's office.Placed in walking boot and told to wear 24/7 except when bathing as it would be extremely easy to dislocate big toe again, nothing is attached to it yet, untill scar tissue adheres to it. Go back in 4 weeks, taking Percocet. question, I think it has already dislocated again, felt funny when boot off to bathe. Just how easy is it to dislocate this toe, and what can I expect, esp after scar tissue builds up? Do I have to go through reduction again if dislocated or pin is better option? Does my age affect the healing period? Thanks for any and all answers.
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First Helper User Profile Gaelic

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replied December 21st, 2012
Especially eHealthy

A patient's age is not so much of a factor in healing, as is the patient' health and medical conditions (and medicines). In other words, if a patient has diabetes, then he/she may have problems with wound healing, and it does not matter if the patient is 40 or 70 years of age.

You do not state if the first metatarsal dislocation was at the TMTJ or the MTPJ (at the midfoot or where the great toe attaches to the metatarsal). You also state that you had a fusion after a failed hallux valgus surgery, which is usually at the MTPJ. So, if you dislocated the first metatarsal after a fusion, that would entail either breaking the plate, or pulling out the screws.

If the dislocation was at the TMTJ (the LisFranc joints of the midfoot), it is actually pretty easy to redislocate that joint.

If you think that the bones have shifted, you should contact your foot surgeon.

Good luck.
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replied December 22nd, 2012
ssHi Gaeilic, thank you first of all for answering, I did not think I was going to get an answer.I just got the actual report yesterday as well as a copy of the Xrays, on Video. I used the wrong terms when saying First Metatarsal as dislocated, I should have just said, Big Toe. Here is the report from day it was first Xrayed and then the followup a couple of days ago, I do appreciate anymore feedback.( thanks in advance...)
Dec. 14th, Findings: There is a fraction-dislocation of the distal phalanx of the great toe. The distal phalanx has been dislocated dorsally. Small medial fracture fragement is seen. Solid Fusion across the MTP joint and dorsal plate ans screws are noted.The remaining bones of the foot show mild age appropriate degenerative changes.
Impression: 1. Fracture-dislocation of the distal phalanx of the great toe.
2: Status post instrumented fusion of the first Metatarsophalangeal joint.
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Dec. 19th, 2012,( after relocation of big toe in surgeons office )

Findings: The bone mineralization is diffusely diminished. The dislocated distal phalanx is now re-located, but there is clearly an oblique intra-articular fracture of the distal phalanx of the first digit. The patient has had fusion of the first metatarsal and proximal phalanx. A plate and multiple transversing screws are noted., fusion seems to be complete.
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Impression: Relocated distal phalanx of the first digit, but there is clearly an oblique intra-articular fracture of the base of the distal phalanx. There is no significent displacement of the distal phalanx fracture fragement.-------------------------

Ok, so If I understand correctly, there is also a fracture of the first digit of the toe, above the area of the fusion. Here are my questions, can you explain in layman's terms please? What is an oblique intra -artiular fracture, does this involve the ligaments, tendons?Also what does , "The bone mineralization is diffusely diminished", mean? Any idea of how long a fracture of this type would take to heal, and if the ligaments, tendons were all torn, not attached, how long does it take for new tissue to adhere to the bone, etc. Thank you again for any suggestions and explaining terms to me. Happy Holidays.
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