Clinical pathodynamics of plantar dislocation of the first metatarsophalangeal joint

Plantar dislocation of the first metatarsophalangeal joint is an extremely rare primary hyperflexion injury of forefoot with potential for more complex progression. Less severe injuries are common mainly in ballet dancers and to a lesser extent in footballers. We are proposing a new comprehensive biomechanical classification of the hallux metatarsophalangeal joint injuries by extending and modifying the classification of hallux metatarsophalangeal sprains by Clanton et al. We also believe that simulation can not always exactly recreate the clinical setting for pathodynamic analysis and interpretation of diverse variations of basic mechanism, progressive disruption of normal pattern of anatomy and final presentation of injury. Therefore, we analysed the dynamic progression of forces in the reported clinical scenarios of plantar dislocation of the first metatarsophalangeal joint in orthopaedic literature to facilitate strategic understanding of the sequence of forces contributing to the injury and provide the clinician with a clear plan for execution of management. Plantar dislocation of the first metatarsophalangeal joint is best described as Dancer's dislocation from the classic sur les pointe through our modification of the classification of Clanton et al.