Subtalar dislocation: Difference between revisions
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==Background== | ==Background== | ||
[[File:Subtalar Joint.png|thumb|Talus and subtalar joint]] | |||
*Usually high-energy trauma | *Usually high-energy trauma | ||
*80% medial dislocations | *80% medial dislocations | ||
*25% open, with lateral more likely | *25% open, with lateral more likely | ||
*Associated with fractures ~50% | *Associated with [[foot Fractures|fractures]] ~50% | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC2691513 wjem-10-92f1.png|thumb|Right foot of an adult patient with a medial subtalar dislocation.]] | |||
[[File:PMC4178312 1752-1947-8-313-2.png|thumb|Subtalar dislocation in pediatric patient with prominent head of talus on exam.]] | |||
===Medial=== | ===Medial=== | ||
*Foot displaced to supination | *Foot displaced to supination | ||
| Line 15: | Line 18: | ||
{{Foot diagnoses}} | {{Foot diagnoses}} | ||
== | ==Evaluation== | ||
[[File: | [[File:PMC2691513 wjem-10-92f2.png|thumb|Anteroposterior (panel A) and lateral (panel B) radiographs of the right ankle of an adult demonstrating a medial subtalar dislocation.]] | ||
*Xrays | *Xrays | ||
| Line 25: | Line 28: | ||
*Talar head inferior to navicular on lateral XR | *Talar head inferior to navicular on lateral XR | ||
== | ==Management== | ||
*Closed reduction and short leg NWB cast first-line, with ortho | *Closed reduction and short leg NWB cast first-line, with ortho consult | ||
*Reduce with ankle plantarflexed, then hindfoot inversion/eversion | *Reduce with ankle plantarflexed, then hindfoot inversion/eversion | ||
*Requires CT after reduction for associated fractures | *Requires CT after reduction for associated fractures | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
Latest revision as of 23:27, 31 March 2021
Background
- Usually high-energy trauma
- 80% medial dislocations
- 25% open, with lateral more likely
- Associated with fractures ~50%
Clinical Features
Medial
- Foot displaced to supination
Lateral
- Foot displaced to pronation
Differential Diagnosis
Foot diagnoses
Acute
- Foot and toe fractures
- Subtalar dislocation
- Metatarsophalangeal joint sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Paronychia
- Tinea pedis
- Morton's neuroma
- Diabetic neuropathy
Evaluation
- Xrays
Medial
- Talar head superior to navicular on lateral XR
Lateral
- Talar head inferior to navicular on lateral XR
Management
- Closed reduction and short leg NWB cast first-line, with ortho consult
- Reduce with ankle plantarflexed, then hindfoot inversion/eversion
- Requires CT after reduction for associated fractures
Disposition
See Also
References
- Weatherford B. Talar neck fractures. Orthobullets, last updated 12/19/14. http://www.orthobullets.com/trauma/1048/talar-neck-fractures.
- Judd DB, Kim DH. Foot Fractures Frequently Misdiagnosed as Ankle Sprains. Am Fam Physician. 2002 Sep 1;66(5):785-795.