MANUAL MINORS
Foot dislocations are serious injuries involving the separation of joint surfaces in various foot joints, such as the tarsal, metatarsal, and phalangeal joints. These injuries typically result from high-energy trauma, such as falls from heights or motor vehicle accidents. The most common types include Lisfranc dislocation (tarsometatarsal joint) and subtalar dislocation.
Diagnosis
Diagnosis is based on the mechanism of injury and clinical presentation, which typically includes visible deformity, intense pain, swelling, and difficulty moving or bearing weight on the foot. X-rays in multiple views (anteroposterior, lateral, and oblique) are required. In some cases, a CT scan is helpful to assess the severity of the injury and plan treatment.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Foot fracture | Similar pain but associated with bone disruption rather than joint displacement. |
Ankle sprain | Pain and swelling around the ankle without joint dislocation. |
Ankle dislocation | Displacement of the ankle joint surfaces rather than foot dislocation. |
Severe foot contusion | Pain and swelling without visible dislocation on imaging. |
Emergency Management
In the emergency setting, immediate management includes closed reduction of the dislocation under sedation or local anaesthesia, provided there are no contraindications. The foot should be immobilised with a posterior splint or short cast until the patient can be evaluated by an orthopaedic specialist. Post-reduction X-rays are needed to confirm proper alignment. Pain control with NSAIDs or stronger analgesics is crucial.
Definitive Treatment
Definitive treatment depends on the type and complexity of the dislocation. In many cases, closed reduction followed by immobilisation for 6-8 weeks is sufficient. However, if the reduction is unstable or there is associated ligament or bone damage, surgery may be required for internal fixation with screws or plates. Postoperative rehabilitation is essential to restore mobility and prevent long-term complications, such as arthritis.
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