Foot Dislocation Follow-up
- Author: Christopher M McStay, MD; Chief Editor: Rick Kulkarni, MD more...
Further Inpatient Care
Reduction of some foot dislocations, especially isolated dislocations of the talus or some of the more complex dislocations of the Lisfranc joint complex, can be very difficult and inadvisable in the ED. In these cases, consulting an orthopedic specialist is always wise. Closed reduction is frequently insufficient and open reduction and internal fixation are required.
Urgent reduction of a dislocation in the ED is often necessary to prevent further vascular or neurological compromise. Whenever possible, ensure adequate analgesia; conscious sedation may be required. The joint should be reduced using gentle traction, and the limb should then be immobilized. Further therapy or operative intervention may be required after this initial reduction.
Further Outpatient Care
As noted above, except for simple dislocations of the toes, these injuries frequently require the services of an orthopedic surgeon who is responsible for the long-term follow-up of these patients.
Inpatient & Outpatient Medications
Analgesia is very important. Narcotics may be required. If the dislocation is open, antibiotics are essential.
Transfer
Most of these injuries, with the exception of simple metatarsophalangeal (MTP) and interphalangeal (IP) dislocations, should be managed by an orthopedic specialist. If a specialist is not available, patients should be transferred to the nearest institution able to offer this service.
Deterrence/Prevention
Many of these injuries are due to MVCs. Strategies to reduce the number of MVCs, such as encouraging and enforcing the drinking and driving laws, will have an impact on the number of these injuries.
Complications
One of the major complications of dislocations of the foot involves a failure to make the diagnosis. Some of these dislocations can be subtle, especially those around the Lisfranc joint complex. These dislocations often are missed, resulting in significant morbidity.
- Other complications
- Infection as a result of compound dislocations or, occasionally, as a postoperative complication
- Long-term stiffness of the foot
- Foot pain not specifically localized to one area
- Secondary osteoarthritis
- Avascular necrosis, especially of the talus, after a total talar dislocation
- Damage to the medial plantar nerve with associated wasting of the intrinsic muscles of the foot (rare)
- Compartment syndrome
- These injuries are associated with long-term morbidity in a significant proportion of patients.
- In one study, 48% of patients with midfoot dislocations (Chopart and Lisfranc joints) had a fair or poor result at follow-up 20-56 months after the injury. Fair or poor in this classification indicated substantial limitation of activities.[12] The authors found that the quality of the initial reduction was the major determinant for obtaining an excellent long-term result.
Prognosis
Prognosis is generally good.
Patient Education
For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article Broken Foot.
Englanoff G, Anglin D, Hutson HR. Lisfranc fracture-dislocation: a frequently missed diagnosis in the emergency department. Ann Emerg Med. Aug 1995;26(2):229-33. [Medline].
Sharda P, DuFosse J. Lateral subtalar dislocation. Orthopedics. Jul 2008;31(7):718. [Medline].
Camarda L, Martorana U, D'Arienzo M. Posterior subtalar dislocation. Orthopedics. Jul 2009;32(7):530. [Medline].
Jungbluth P, Wild M, Hakimi M, Gehrmann S, Djurisic M, Windolf J. Isolated subtalar dislocation. J Bone Joint Surg Am. Apr 2010;92(4):890-4. [Medline].
de Palma L, Santucci A, Marinelli M, Borgogno E, Catalani A. Clinical outcome of closed isolated subtalar dislocations. Arch Orthop Trauma Surg. Jun 2008;128(6):593-8. [Medline].
Ricci RD, Cerullo J, Blanc RO, McMahon PJ, Buoncritiani AM, Stone DA, et al. Talocrural dislocation with associated weber type C fibular fracture in a collegiate football player: a case report. J Athl Train. May-Jun 2008;43(3):319-25. [Medline]. [Full Text].
DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. Foot Ankle Clin. Jun 2009;14(2):169-86. [Medline].
Brunet JA. Pathomechanics of complex dislocations of the first metatarsophalangeal joint. Clin Orthop Relat Res. Nov 1996;(332):126-31. [Medline].
Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC. Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Joint Surg Am. Apr 2009;91(4):892-9. [Medline].
Woodward S, Jacobson JA, Femino JE, Morag Y, Fessell DP, Dong Q. Sonographic evaluation of Lisfranc ligament injuries. J Ultrasound Med. Mar 2009;28(3):351-7. [Medline].
Bohay DR, Manoli A 2nd. Subtalar joint dislocations. Foot Ankle Int. Dec 1995;16(12):803-8. [Medline].
Perron AD, Brady WJ, Keats TE. Orthopedic pitfalls in the ED: Lisfranc fracture-dislocation. Am J Emerg Med. Jan 2001;19(1):71-5. [Medline].
Davis CA, Lubowitz J, Thordarson DB. Midtarsal fracture-subluxation. Case report and review of the literature. Clin Orthop Relat Res. Jul 1993;(292):264-8. [Medline].
Karasick D. Fractures and dislocations of the foot. Semin Roentgenol. Apr 1994;29(2):152-75. [Medline].
Milenkovic S, Radenkovic M, Mitkovic M. Open subtalar dislocation treated by distractional external fixation. J Orthop Trauma. Oct 2004;18(9):638-40. [Medline].
Mulier T, Reynders P, Sioen W, et al. The treatment of Lisfranc injuries. Acta Orthop Belg. Jun 1997;63(2):82-90. [Medline].
Prokuski LJ, Saltzman CL. Challenging fractures of the foot and ankle. Radiol Clin North Am. May 1997;35(3):655-70. [Medline].
Saab M. Lisfranc fracture--dislocation: an easily overlooked injury in the emergency department. Eur J Emerg Med. Jun 2005;12(3):143-6. [Medline].
Simon JP, Van Delm I, Fabry G. Fracture dislocation of the tarsal navicular. Acta Orthop Belg. 1993;59(2):222-4. [Medline].
Wagner R, Blattert TR, Weckbach A. Talar dislocations. Injury. Sep 2004;35 Suppl 2:SB36-45. [Medline].
Yee LY, Lopez JR. Transdermal fentanyl. Ann Pharmacother. Nov 1992;26(11):1393-9. [Medline].
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