Foot sprains: causes, symptoms, diagnosis, treatment

Ankle dislocations are usually combined with fractures of the malleoli or the anterior and posterior edges of the tibia. Isolated dislocations of segments of the foot or individual bones are relatively rare.

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Subtalar dislocation of the foot

ICD-10 code

• S93.0. Dislocation of ankle joint.
• S93.3. Dislocation of other and unspecified part of foot.

Dislocation occurs at the level of the talocalcaneal and talonavicular joints due to excessive indirect force. Most often, as a result of excessive flexion and internal rotation of the foot, a dislocation occurs to the rear with supination and internal rotation. However, when the direction of force changes, dislocations of the foot to the front, outward and inward are possible.

Symptoms of subtalar dislocation of the foot

Pain is characteristic. Foot deformation depends on the type of displacement. In posterior-internal dislocations, the forefoot is shortened. The foot is displaced inwards and backwards, supinated and maximally bent. The talus bone protrudes along the outer surface.

Diagnosis of subtalar dislocation of the foot

The final diagnosis is made after an X-ray.

Conservative treatment of subtalar dislocation of the foot

General anesthesia. The dislocation is treated immediately after the diagnosis is established. Delay can lead to the formation of bedsores in places of pressure from protruding bones and due to rapidly increasing edema.

The patient is placed on his back, the leg is bent to an angle of 90° at the knee and hip joints. The lower leg is fixed. The foot is shifted even more towards the dislocation and traction is performed along the axis of the displaced segment. The second stage involves creating a counter-support in the protruding bone, and the foot is returned to the correct position. When repositioning, a click is heard and movements appear in the ankle joint. A posterior trough-shaped deep splint is applied from the tips of the toes to the middle third of the thigh for 3 weeks. With moderate edema, a circular bandage can be applied for the same period, but immediately cut it lengthwise and press the edges. Flexion in the knee joint should be 30°, in the ankle - 0°. After 3 weeks, the plaster cast is replaced with a circular one, shortening it to the upper third of the lower leg. The immobilization period is extended for another 8 weeks. Loading of the limb in a plaster cast is permitted no earlier than after 2 months.

Approximate period of incapacity

Working capacity is restored in 3-3.5 months. The patient should use an instep support for a year.

Dislocation of the talus

ICD-10 code

S93.3. Dislocation of other and unspecified part of foot.

The mechanism of injury is indirect: excessive adduction, supination and plantar flexion of the foot.

Symptoms of a dislocated talus

Pain at the site of injury, ankle joint is deformed. Foot is deflected inwards. A dense protrusion is palpated along the anterior outer surface of the foot. The skin above it is whitish due to ischemia.

Diagnosis of talus dislocation

The radiograph reveals a dislocation of the talus.

Conservative treatment of talus dislocation

The dislocation is corrected under general anesthesia and immediately after diagnosis due to the risk of skin necrosis in the area of the talus. The patient is positioned in the same way as for correcting a subtalar dislocation. Intensive traction is applied to the foot, giving it even greater plantar flexion, supination, and adduction. The surgeon then presses the talus inward and backward, trying to turn it and move it into its own bed. The limb is immobilized with a circular plaster cast from the middle of the thigh to the tips of the toes with knee flexion at an angle of 30°, and 0° at the ankle. The bandage is cut lengthwise to prevent compression. After 3 weeks, the bandage is changed to a plaster boot for 6 weeks. After the immobilization is eliminated, rehabilitation treatment is performed. To avoid aseptic necrosis of the talus, weight bearing on the limb is permitted no earlier than 3 months after the injury.

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Dislocation of the Chopart joint

ICD-10 code

S93.3. Dislocation of other and unspecified part of foot.

Dislocation of the talonavicular and calcaneocuboid joints occurs with a sharp abductive or adductive (usually abductive) rotation of the forefoot, which shifts to the rear and to one side.

Symptoms of dislocation in the Chopart joint

Sharp pain, foot deformed, swollen. Load on the limb is impossible. Blood circulation in the distal part of the foot is impaired.

Diagnosis of dislocation in the Chopart joint

The radiograph reveals a violation of congruence in the Chopart joint.

Conservative treatment of dislocation in the Chopart joint

The dislocation is eliminated immediately and only under anesthesia. Traction is performed on the heel area and the forefoot. The surgeon eliminates the displacement by applying pressure to the back of the distal part of the foot and to the side opposite to the displacement.

A plaster boot with a well-modeled arch is applied. The limb is elevated for 2-4 days, after which walking on crutches is allowed. The immobilization period is 8 weeks, then a removable splint is applied for 1-2 weeks, in which the patient walks on crutches with a gradually increasing load. Then rehabilitation treatment is carried out.

Approximate period of incapacity

Working capacity is restored after 12 weeks. Wearing an instep support for a year is recommended.

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Lisfranc joint dislocation of the foot

ICD-10 code

S93.3. Dislocation of other and unspecified part of foot.

Dislocations of the metatarsal bones often occur as a result of direct violence, and are often combined with fractures of the base of these bones. The displacement of the dislocated bones can occur outward, inward, to the dorsal or plantar side.

Symptoms of Lisfranc Dislocation of the Foot

Pain at the site of injury. The foot is deformed: shortened, thickened and widened in the forefoot, moderately supinated. The supporting function of the foot is impaired.

Diagnosis of Lisfranc joint dislocation of the foot

The radiograph reveals a dislocation in the Lisfranc joint.

Conservative treatment of dislocation of the foot in the Lisfranc joint

The reduction is performed under general anesthesia. Assistants stretch the foot along the longitudinal axis, capturing the anterior and posterior sections together with the shin. The surgeon eliminates the existing displacements by pressing the fingers in the direction opposite to the dislocation.

The limb is immobilized with a plaster boot for 8 weeks. The leg is elevated, cold is applied to the foot, and the blood circulation is monitored. The circular plaster bandage is removed after the period has elapsed and a removable plaster splint is applied for 1-2 weeks. Loading of the limb is permitted after 8-10 weeks.

Approximate period of incapacity

Working capacity is restored after 3-3.5 months. Wearing an instep support is recommended for a year.

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Dislocation of toes

Of all the dislocations in the joints of the lower limb, only dislocations of the toes are subject to outpatient treatment. The most common among them is the dislocation of the first toe in the metatarsophalangeal joint to the dorsal side.

ICD-10 code

S93.1. Dislocation of toe(s).

Symptoms of dislocated toes

The first toe is deformed. The main phalanx is located above the metatarsal at an angle open to the back. There is no movement in the joint. A positive symptom of spring resistance is noted.

Diagnosis of dislocated toes

X-rays are used to detect dislocation of the first toe.

Treatment of dislocated toes

The method of reduction is exactly the same as for the elimination of dislocation of the first finger of the hand. After the manipulation, the limb is immobilized with a narrow dorsal plaster splint from the lower third of the shin to the end of the finger for 10-14 days. Subsequent restorative treatment is prescribed.

Approximate period of incapacity

Working capacity is restored within 3-4 weeks.

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