Foot Dislocation Workup

Updated: May 10, 2016
  • Author: Christopher M McStay, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Workup

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.

Up to 20% of Lisfranc fracture-dislocations are misdiagnosed or missed during the initial evaluation. [10] Lisfranc injuries typically present to EDs with pain particularly with weight bearing, with swelling, and after a characteristic mechanism of injury. Diagnosis is via clinical examination and radiologic investigation, typically plain radiographs and CT scans. [11] Sensitivity and specificity of MRI identification of Lisfranc injuries have been reported to be as high as 94% and 75%, respectively. [12]  Ultrasound is now also being used to evaluate Lisfranc injuries. [13]

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Other Tests

Doppler may be performed to detect pulses.

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