II. Epidemiology
- Rare foot dislocation
- Subtalar Dislocations represent only 1 to 2% of all dislocations
- Young men account for a majority of cases
III. Pathophysiology
- High energy injury (e.g. Motor Vehicle Accident, fall from height, sports such as basketball)
- Disruption of two joints (breaking through joint capsules and strong ligaments)
- Talocalcaneal joint
- Talonavicular joint
- Dislocation Direction Based on Midfoot Displacement
- Medial Subtalar Dislocation (65% of cases)
- High force inversion injury while foot is plantar flexed
- Lateral Subtalar Dislocation (35% of cases)
- High force eversion injury while foot is plantar flexed
- Anterior Subtalar Dislocation (rare)
- Posterior Subtalar Dislocation (rare)
- Medial Subtalar Dislocation (65% of cases)
IV. Signs
V. Imaging
- XRay Foot
- Obtain pre-reduction and post-reduction films
- CT Foot
- Evaluate for occult associated injuries
- Associated occult injuries are common and frequently change management
- Fifth Metatarsal Fracture
- Talus Fracture
- Malleolus Fracture
- Osteochondral Fracture
- References
VI. Management
- Closed Reduction
- Perform emergently under Procedural Sedation
- Patient supine with knee flexed to 90 degrees (relaxes calf Muscles)
- Apply inline traction and countertraction
- Accentuate the deformity, and then reverse to reposition
- Interposed tissue may not allow for reduction (Open reduction may be needed)
- Immobilization (4 weeks is typical)
- Referral
- Consult Orthopedics or podiatry for follow-up
- Emergent Consultation indications
- Open Fracture
- Neurovascular compromise
- Non-reducible dislocation
VII. Complications
- Post-Traumatic Arthritis
- Talus necrosis
- Subtalar Joint Stiffness
VIII. References
- Jong and Huang (2022) Crit Dec Emerg Med 36(4): 22-3
- Prada-Cañizares (2016) Int Orthop 40(5):999-1007 +PMID: 26208589 [PubMed]
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Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281506007 |
English | Dislocation of subtalar joint (diagnosis), dislocation subtalar joint, Dislocation of subtalar joint, Dislocation of subtalar joint (disorder) |
Spanish | luxación de la articulación subastragalina (trastorno), luxación de la articulación subastragalina |