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Subtalar Dislocation
Aka: Subtalar Dislocation, Dislocation of Subtalar Joint
- Epidemiology
- Rare foot dislocation
- Subtalar Dislocations represent only 1 to 2% of all dislocations
- Young men account for a majority of cases
- 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)
- Signs
- See Foot Pain for evaluation (including neurovascular exam)
- Midfoot displacement in relation to hindfoot
- Foot is fixed in supination in Medial Subtalar Dislocation
- Foot is fixed in pronation in Lateral Subtalar Dislocation
- 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
- Bibbo (2001) Foot Ankle Int 22(4): 324-8 [PubMed]
- 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)
- Short leg stirrup splint
- Non-weight bearing with Crutches
- Some studies recommend 2 to 3 weeks of immobilization, followed by range of motion Exercises
- Lasanianos (2011) J Orthop Traumatol 12(1): 37-43 [PubMed]
- Referral
- Consult Orthopedics or podiatry for follow-up
- Emergent Consultation indications
- Open Fracture
- Neurovascular compromise
- Non-reducible dislocation
- Complications
- Post-Traumatic Arthritis
- Talus necrosis
- Subtalar Joint Stiffness
- 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]