FOOT DISLOCATION, TALUS |
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General Information
DEFINITION--Injury and displacement of the talus so it no longer touches adjoining bones. Fractures and ligament sprains frequently accompany this dislocation.
BODY PARTS INVOLVED
Talus and adjacent foot bones (tibia, navicular, calcaneus).
Ligaments that hold foot bones together.
Soft tissue surrounding the dislocation site, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Excruciating pain in the foot at the time of injury.
Loss of function in the foot and ankle, and severe pain when attempting to move them.
Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis below the dislocation from pressure on, pinching or cutting of blood vessels or nerves.
CAUSES
Direct or indirect blow to the foot and ankle.
End result of a severe foot sprain.
Congenital abnormality, such as abnormal arches or shallow or malformed joint surfaces.
RISK INCREASES WITH
Contact sports.
Running and jumping events.
Exercise on uneven surfaces.
Previous foot dislocation or sprain.
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 or activities involving running and jumping, protect vulnerable joints. Wear protective devices, such as high-top athletic shoes, and use tape.
Avoid irregular surfaces for running, fast walking, and track and field events.
Warm up adequately before physical activity.
Build your overall strength and muscle tone with a long-term conditioning program.
Avoid contact sports if treatment does not restore a strong, stable foot and ankle.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manipulating the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
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
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels and connective tissue.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding.
Impaired blood supply to the dislocated area.
Death of bone cells due to interruption of the blood supply.
Infection introduced during surgical treatment.
Prolonged healing if activity is resumed too soon.
Recurrent dislocations.
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization with a cast or splint covering the foot and ankle for 2 to 3 weeks. Injured liga-
ments require a minimum of 6 weeks to heal.
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 and ankle 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 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 while 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 in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
Any of the following occur after injury:
Foot deformity.
Difficulty moving the foot.
Numbness, paleness or coldness in the foot. This is an emergency!
Nausea or vomiting.
Any of the following occur after treatment:
Swelling above or below the cast.
Blue or gray skin color 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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