eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Dislocation, Foot: Follow-up
Updated: May 27, 2008
Follow-up
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.4 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.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose dislocation of the foot: Some dislocations, at the Lisfranc joint complex particularly, can be subtle. Clues to the diagnosis include severe pain and edema of the foot. Careful examination of the appropriate radiographs should reveal the diagnosis; however, in some cases, further investigation with CT scanning or MRI may be required. As many as 20% of Lisfranc injuries are thought to be missed on initial presentation.
- Failure to diagnose dislocation of the foot when other, more severe, injuries are present in a multiple-injury victim: The other injuries may be dramatic and distract attention from the foot. A full detailed secondary survey with frequent reassessment is vital in all patients with multiple injuries.
More on Dislocation, Foot |
| Overview: Dislocation, Foot |
| Differential Diagnoses & Workup: Dislocation, Foot |
| Treatment & Medication: Dislocation, Foot |
 Follow-up: Dislocation, Foot |
| References |
| « Previous Page |
References
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Brunet JA. Pathomechanics of complex dislocations of the first metatarsophalangeal joint. Clin Orthop Relat Res. Nov 1996;(332):126-31. [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].
Further Reading
Keywords
foot dislocation, dislocation foot, motor vehicle collision, MVC, hindfoot, talus, calcaneus, midfoot, navicular, cuboid, cuneiforms, forefoot, metatarsals, phalanges, subtalar joint, compartment syndrome, degenerative arthritis, diabetes mellitus, denervation of the foot, Charcot joints, Lisfranc dislocation, subtalar dislocation, peritalar dislocation, isolated fracture dislocation, cuboid fracture, cuneiform fracture, tarsometatarsal dislocation
