recurrent bilateral 3rd digit dislocations- suggestions anyone?

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Hi all
Today I have seen a 15 year old girl with a history of recurrent 3rd digit dislocation/ subluxation (this is subjective) in both feet. Her mother has said this has been ongoing for just over 2 years with one of the 3rd toes on either foot dislocating approximately every 3 months. The young girl can tell when it is going to happen as she gets a pain on the dorsum of the foot (in the area of the MTPJs) as well as anterior ankle pain and then if she is moving the foot at all or walking the toe will dislocate. This has even occurred while putting on shoes. Following this, the toe puts itself back in position and while there is some pain following it doesnt really affect function.

Does anyone have any ideas / suggestions on cause or areas to look at? I have not come across this before.
Hypermobile foot joints
Medially deviated STJ axis
Clawing digits as well as "crooked" toes medially and laterally
stage 1 HAV bilaterally
Pain she describes prior to dislocation seems to be EDL, however muscle testing all seems within normal ranges

Her previous podiatrist has done manipulation, however this does not prevent re-dislocation. Also considering possibility of previous bilateral freiberg's of 3rd which may have caused instability at this joint. At this stage, I am open to any ideas?

Thanks in advance!

 

Hi,
an interesting conundrum. One question i would ask- is the dislocation visible or is it perceived?
if the patient actually sees the toe dislocate out of joint and has to relocate the digit then further investigation of the foot is required to include standing x ray and possible ultrasound to reproduce the dislocation.
i suspect it is a perceived dislocation however with the toe appearing normal on examination post event. in this case i would be highly suspicious of an inter phalangeal mass such as a bursa or neuroma, again ultrasound may be of use but i would try to ellicit a Mulder's click to help with the diagnosis.
Hope that this helps,

Lyndon

 

As Lyndon asked is it dislocation or are the extensors cramping/going into spasm.

What is the beighton score?

Does it happen to any other joints?

GGH?

I am thinking on the lines of possible Ehlers Dandros (or other hyperobilty syndromes )if hyper mobile, occurs to other joints etc


Thanks,

Nick