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Image challenge
To reduce or not to reduce?
  1. Vikram Kishor Kandhari,
  2. Haroon Mumtaz,
  3. Shahbaz Ahmed
  1. Trauma and Orthopaedics, Ysbyty Gwynedd, Bangor, UK
  1. Correspondence to Mr Vikram Kishor Kandhari; dr.vikramkandhari{at}gmail.com

https://doi.org/10.1136/emermed-2024-214154

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    Clinical introduction

    A 50-year-old construction worker presented to the ED with a history of fall. He had pain in the right foot and difficulty weight bearing. The patient was assessed and diagnosed to have a closed isolated injury to the right foot (figure 1). The foot was neurovascularly intact. Examination only showed painful restriction of plantar flexion of the big toe.

    Figure 1

    Clinical image of the foot at presentation.

    Question

    What is the most likely diagnosis?

    1. Dislocation of the first metatarsophalangeal joint

    2. Rupture of the extensor hallucis longus tendon

    3. Great toe interphalangeal joint dislocation

    4. Fracture of base of proximal phalanx of great toe

    Answer: A

    Dislocation of the first metatarsophalangeal joint

    Explanation

    The patient has type 1 traumatic dislocation of the …

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    Footnotes

    • Handling editor Sarah Edwards

    • Contributors All authors have contributed equally to the writing of this manuscript. All authors were also involved in treating the patient.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.