Dislocated first metatarsophalangeal joint
"Painful foot" - history supplied by Emergency Department.
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There is dorsal dislocation of the first metatarsophalangeal joint with no associated fracture.
This is a good example of why it is important to take appendicular trauma radiographs in multiple planes.
Upon first viewing the frontal image, the dislocation was not initially appreciated - only visible as a sclerotic line. The dislocation is much more obvious in subsequent images.
It is also an example of poor history documentation on the film request. While it is important to always look at the entire film, "Painful foot" may indicate to the radiologist that no trauma was involved, whereas this type of injury usually occurs following relatively high energy trauma.