Stubbing Injuries to the Hallux

Stubbing injuries to the hallux, previously unreported, result in specific fractures and fracture dislocations of the interphalangeal joint. In the six cases seen, the initial injury remained unrecognized for 3 to 6 weeks. The mechanism of injury consisted of stubbing the hallux while barefoot, driving it proximally and dorsally. The mildest injury consisted of single or multiple relative un-displaced fractures of either the lateral or medial condyle of the proximal phalanx. Further force resulted in condy-lar displacement and rotation to complete dorsal dislo-cation of the distal phalanx, carrying with it either one or both condyles. Treatment in these relatively symptomatic late cases was expectant. One patient ultimately required an interphalangeal fusion. Fractures and fracture-dislocations of the hallux due to stubbing injuries comprise a unique, if some-what uncommon, entity. In approximately 25,000 foot patients treated over the past 18 years, only six such cases have been seen. All cases involved the inter-phalangeal joint. Not included in this series are cap-sular and conjoined tendon injuries of the metatarso-phalangeal joint usually associated with sports inju-ries. All of the patients were females in their fourth or fifth decade. The mechanism of injury was the same, namely, a stubbing of the hallux in a proximal and dorsal direction while walking barefoot. All of the patients had relatively mild discomfort which was in-terpreted in most instances as a "sprain. " In every case, the diagnosis was either overlooked by the primary physician, or the patient did not seek early medical care. The result was that all of the patients were seen by me relatively late, namely, 3 to 6 weeks post injury. CLINICAL AND ROENTGENOGRAPHIC FINDINGS All patients presented with mild to moderate discom-fort, local swelling, and moderately severe limitatio