FOOT DISLOCATION, SUBTALAR |
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General Information
DEFINITION--Injury to a joint in the foot below the talus so that adjoining bones are displaced from their normal position and no longer touch each other. A minor dislocation is called a SUBLUXATION. Joint surfaces still touch, but not in normal relation to each other.
BODY PARTS INVOLVED
Any of the foot bones below the talus.
Ligaments that hold foot bones in place.
Soft tissue surrounding the dislocated bones, including nerves, tendons, muscles and blood vessels.
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SIGNS & SYMPTOMS
Excruciating pain at the time of injury.
Inability to bear weight and walk.
Severe pain when attempting to move the foot.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis below the dislocation from pinching, cutting or pressure on blood vessels or nerves.
CAUSES
Direct blow to the foot.
End result of a severe foot sprain.
Congenital abnormality, such as a shallow or malformed joint surface.
RISK INCREASES WITH
Participation in contact sports.
Running or fast walking.
Exercise on uneven terrain or surfaces.
Previous foot sprains or dislocations.
Repeated injury to any joint in the foot.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
For participation in contact sports, protect vulnerable joints with supportive devices, such as wrapped elastic bandages, tape or high-top athletic shoes.
Warm up adequately before physical activity.
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Avoid irregular surfaces for running, fast walking, or track and field events.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment, which includes manipulation of the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the foot, ankle and adjacent bones.
POSSIBLE COMPLICATIONS
Damage to nearby nerves or major blood vessels.
Death of bone cells caused by interruption of the blood supply.
Excessive internal bleeding at the dislocation site.
Shock or loss of consciousness.
Prolonged healing if activity is resumed too soon.
Recurrent dislocations, particularly if a previous dislocation has not healed completely.
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization for 6 to 8 weeks with a cast from knee to toes. Complete healing of injured ligaments requires a minimum of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing and shoe, if possible, but don't move the injured area to do so.
Immobilize the foot and ankle with padded splints.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
IF A CAST IS NOT NECESSARY:
Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, heat ointments and liniments, or whirlpools.
Wrap the foot with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
IF A CAST IS NECESSARY:
See Appendix 2 (Care of Casts).
See Appendix 3 (Safe Use of Crutches).
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen or aspirin to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
Antibiotics to fight infection.
ACTIVITY
IF SURGERY IS NOT NECESSARY:
Resume sports participation after clearance from your doctor.
IF SURGERY IS NECESSARY:
Avoid vigorous exercise for 6 weeks after surgery. Then resume normal activities gradually.
Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
Any of the following occur after injury:
Numbness, paleness or coldness in the foot. This is an emergency!
Foot deformity.
Difficulty moving the foot.
Nausea or vomiting.
Any of the following occur after treatment:
Swelling above or below the cast.
Blue or gray skin color, particularly under the toenails.
Constipation.
Any of the following occur after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection: headache, muscle aches, dizziness, or a general ill feeling and fever.
New, unexplained symptoms develop. Drugs used in treatment may cause side effects.
Foot dislocations that you can "pop" back into normal position occur repeatedly.
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