Foot Dislocation Workup

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

Laboratory Studies

Laboratory studies are generally not indicated for diagnosing foot dislocations. However, if an intravenous line is placed for conscious sedation purposes, routine preoperative laboratory samples may be drawn to facilitate definitive management of foot dislocations.

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Imaging Studies

Routine radiography of the foot should include 3 views: anteroposterior, lateral, and 45 º internal oblique.

  • The hindfoot is assessed via the lateral projection and the midfoot and forefoot via the anteroposterior and oblique projections.
  • Any identified hindfoot injury should prompt standard imaging of the ankle.
  • Additional views, such as the Harris (axial) view to evaluate the subtalar joint and calcaneus, can be obtained to improve imaging of certain areas of the foot.
  • Weightbearing views may reveal subtle Lisfranc abnormalities.

Increasingly, CT scanning is being used to help evaluate fractures and dislocations in the foot and in particular to help evaluate calcaneal and talar fractures.

MRI is often used to diagnose stress fractures and to evaluate the various tendons and ligaments of the foot. Sensitivity and specificity of MRI identification of Lisfranc injuries have been reported to be as high as 94% and 75%, respectively.[9]

Ultrasound is now being used to evaluate Lisfranc injuries.[10]

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Other Tests

Doppler may be performed to detect pulses.

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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

References

  1. 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].

  2. Sharda P, DuFosse J. Lateral subtalar dislocation. Orthopedics. Jul 2008;31(7):718. [Medline].

  3. Camarda L, Martorana U, D'Arienzo M. Posterior subtalar dislocation. Orthopedics. Jul 2009;32(7):530. [Medline].

  4. 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].

  5. 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].

  6. 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].

  7. DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. Foot Ankle Clin. Jun 2009;14(2):169-86. [Medline].

  8. Brunet JA. Pathomechanics of complex dislocations of the first metatarsophalangeal joint. Clin Orthop Relat Res. Nov 1996;(332):126-31. [Medline].

  9. 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].

  10. 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].

  11. Bohay DR, Manoli A 2nd. Subtalar joint dislocations. Foot Ankle Int. Dec 1995;16(12):803-8. [Medline].

  12. 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].

  13. 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].

  14. Karasick D. Fractures and dislocations of the foot. Semin Roentgenol. Apr 1994;29(2):152-75. [Medline].

  15. Milenkovic S, Radenkovic M, Mitkovic M. Open subtalar dislocation treated by distractional external fixation. J Orthop Trauma. Oct 2004;18(9):638-40. [Medline].

  16. Mulier T, Reynders P, Sioen W, et al. The treatment of Lisfranc injuries. Acta Orthop Belg. Jun 1997;63(2):82-90. [Medline].

  17. Prokuski LJ, Saltzman CL. Challenging fractures of the foot and ankle. Radiol Clin North Am. May 1997;35(3):655-70. [Medline].

  18. Saab M. Lisfranc fracture--dislocation: an easily overlooked injury in the emergency department. Eur J Emerg Med. Jun 2005;12(3):143-6. [Medline].

  19. Simon JP, Van Delm I, Fabry G. Fracture dislocation of the tarsal navicular. Acta Orthop Belg. 1993;59(2):222-4. [Medline].

  20. Wagner R, Blattert TR, Weckbach A. Talar dislocations. Injury. Sep 2004;35 Suppl 2:SB36-45. [Medline].

  21. Yee LY, Lopez JR. Transdermal fentanyl. Ann Pharmacother. Nov 1992;26(11):1393-9. [Medline].

 
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