Subtalar Dislocation

Description

Subtalar dislocation is an injury to a joint in the foot below the ankle joint (talus), causing adjoining bones to be displaced from their normal position, so that they no longer touch each other. A subluxation of this joint is when the joint surfaces still touch but are not in normal relationship to each other. This is uncommon.

Common signs and symptoms

• Severe pain when attempting to move the foot or ankle and an inability to stand or walk on the foot

• Tenderness, obvious deformity, swelling, and bruising at the injury site

• Numbness or paralysis below the dislocation from pinching, cutting, or pressure on the blood vessels or nerves (uncommon)

Causes

• A direct blow, twisting injury, or landing wrong on the foot

• Congenital abnormality (birth defect), such as a shallow or malformed joint surface

Factors that increase risk

• Participation in contact sports, those that require jumping and landing (basketball, volleyball), and sports in which cleats are worn

• Running or fast walking and exercise on uneven terrain or surfaces

• Previous foot or ankle sprains or dislocations

• Repeated injury to any joint in the foot

• Poor physical conditioning (strength, flexibility)

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness, ankle and leg muscle strength, endurance, and flexibility training.

• For jumping sports (basketball, volleyball) or contact sports, protect vulnerable joints with supportive devices, such as braces, wrapped elastic bandages, tape, or high-top athletic shoes.

• For sports that require cleats or spikes, use an appropriate length for the sport, the turf, and field conditions.

• Avoid irregular surfaces for running, fast walking, or track and field events.

• Wear proper protective equipment, and ensure a correct fit.

Expected outcome

With appropriate repositioning of the joint (reduction) and immobilization, complete healing of ligaments requires a minimum of 6 weeks. Stiffness of the subtalar joint nearly always occurs after rehabilitation and after healing is complete.

Possible complications

• Damage to nearby nerves or major blood vessels, as well as associated fracture or joint cartilage injury as a result of the dislocation or reduction of the dislocation

• Prolonged healing or recurrent dislocation if activity is resumed too soon

• Death of bone cells caused by interruption of the blood supply (rare)

• Excessive bleeding in the foot or at the dislocation site, causing pressure and injury to nerves and blood vessels (rare)

• An unstable or arthritic joint following repeated injury or delayed treatment

General treatment considerations

After immediate repositioning of the bones of the joint by trained medical personnel, treatment consists of ice and medications to relieve pain. Although reduction can be performed without surgery, it is occasionally necessary to perform surgery to restore the joint to its normal position and to repair ligaments and tendons. Elevating the injured foot and ankle at or above heart level helps reduce swelling. Immobilization by splinting, casting, or bracing for 2 to 8 weeks is usually recommended to protect the joint while the ligaments heal. After immobilization, stretching and strengthening of the injured and weakened joint and surrounding muscles are necessary because of the injury and immobilization. These exercises may be done with or without the assistance of a physical therapist or athletic trainer.

Medication

• General anesthesia or muscle relaxers may be used to help make joint repositioning possible.

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed as necessary. Use these only as directed, and take only as much as you need.

Heat and cold

• Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

When to call your doctor

• Pain, tenderness, or swelling worsens despite treatment.

• You experience pain, numbness, or coldness in your foot.

• A blue, gray, or dusky color appears in your toenails.

• Any of the following occur after surgery: increased pain, swelling, redness, drainage, bleeding in the surgical area, or signs of infection such as headache, muscle aches, dizziness, or a general ill feeling with fever.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Range of Motion and Stretching Exercises

Subtalar Dislocation

Phase I

These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:

• Flexible tissue is more tolerant of the stresses placed on it.

• A gentle stretching sensation should be felt.

Range of motion active dorsiflexion/plantarflexion

1. Perform this exercise with your knee straight and then with your knee bent.

2. Pull your toes and foot toward your body as far as possible, then point your toes away from your as far as possible.

3. Hold each position for ____ seconds.

4. Repeat this exercise ____ times, ____ times per day.

Range of motion ankle alphabet

1. “Write” all the capital letters of the alphabet with your foot and ankle. The motion should come from your foot and ankle, not your hip or knee.

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