Foot Dislocation Treatment & Management

  • Author: Christopher M McStay, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jul 29, 2010
 

Prehospital Care

When the dislocated foot is seen as one of numerous injuries in a patient with major trauma, management of the other potentially life-threatening injuries takes priority.

When the dislocation is an isolated injury, immobilize the limb to make the patient as comfortable as possible and promptly transport the patient.

Control bleeding with direct pressure and cover any open dislocation with a sterile dressing.

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Emergency Department Care

Immediate management may be dictated by concomitant injuries. Assess the neurovascular status of the foot as part of the secondary survey. Consider an urgent reduction of any dislocation that causes significant neurovascular compromise.

In cases of isolated injury, assess and record neurovascular status. Urgent radiographs should be obtained. Make arrangements for referral to an orthopedic specialist for reduction of the dislocation and further management as appropriate.

Remember the possibility of compartment syndrome developing after severe injuries to the foot. Often the signs of compartment syndrome may be initially masked by the severe pain related to the injury. Failure to diagnose this problem can result in serious long-term sequelae for the patient including contractures, deformities, and chronic pain. A high index of suspicion for this complication is required, and measurement of compartment pressures in the foot should be instituted if any findings suggest that this complication is present.

Any open dislocation associated with or without a fracture should typically not be reduced in the ED. Appropriate prophylactic antibiotics should be administered, and the tetanus status of the patient should be updated. Sterile dressings should be applied.

Treatment of subtalar and total talar dislocations include the following:

  • Most subtalar dislocations can be treated with closed reduction under appropriate analgesia and sedation.[11] The interposition of soft tissues may prevent reduction, necessitating open reduction. Consider an urgent reduction if significant neurovascular compromise is evident.
  • Total talar dislocations are often open and, as such, should not be reduced in the ED. If a closed injury is present or if urgent reduction is necessary secondary to neurovascular compromise, reduction may be attempted ideally with appropriate consultation available.
  • With the knee flexed, apply longitudinal traction at the foot. Initial accentuation of the injury followed by reversal of the deformity with pressure over the talus may result in reduction. For example, after distraction, apply an abduction force for a medical dislocation.

Lisfranc dislocations frequently require operative reduction. An orthopedic surgeon should be involved in the care of these injuries. ED care typically involves appropriate analgesia, ice, and elevation.

Dislocations of the toes often can be reduced under local anesthesia (digital block) in the ED with simple longitudinal traction. Dislocations of the first toe may be difficult to reduce.

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Consultations

Urgent ED orthopaedic consultation is indicated for subtalar, total talar, and Lisfranc dislocations.

Additionally, first metatarsophalangeal (MTP) and interphalangeal (IP) dislocations that are open or not reducible require orthopedic consultation. Most other MTP and IP dislocations are easily managed by the ED physician.

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Contributor Information and Disclosures
Author

Christopher M McStay, MD  Assistant Professor, Department of Emergency Medicine, New York University, Bellevue Hospital Center

Christopher M McStay, MD is a member of the following medical societies: American College of Emergency Physicians and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Moira Davenport, MD  Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital

Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS  Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, British Medical Association, and Fellowship of the Australasian College for Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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