Foot
Subtalar Dislocation
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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
Muscle
s)
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
Exercise
s
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-
Trauma
tic
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]
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