MANUAL MINORS
Midfoot or hindfoot dislocations are serious injuries affecting the joints that connect the hindfoot (calcaneus and talus) with the midfoot (navicular, cuboid, and cuneiform bones), compromising the stability and functionality of the foot.
The dislocation of the Lisfranc joint (between the tarsus and the metatarsals) is the most common in the midfoot, while talonavicular and calcaneocuboid dislocations affect the hindfoot. They are usually caused by high-energy trauma, such as falls from height, vehicle accidents, or sports injuries.
Diagnosis
The diagnosis is based on the trauma history, with intense localised pain in the midfoot, evident deformity, swelling, and difficulty bearing weight. Palpation may reveal instability or crepitus in the affected joints.
X-rays in anteroposterior, lateral, and oblique projections of the foot are necessary to assess joint displacement. In complex cases, a CT scan helps plan treatment and determine the extent of bone and joint damage.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Lisfranc fracture | May coexist with dislocation; visible fracture on X-ray. |
Talus fracture | Affects the subtalar joint, with pain and tenderness in the heel. |
Severe ankle sprain | Pain more localised in the ankle, with no visible foot dislocation. |
Foot contusion | Pain and swelling without obvious joint displacement on imaging. |
Emergency Management
In the emergency department, immediate management includes closed reduction of the dislocation under sedation or local anaesthesia, depending on the stability of the injury. The affected foot should be immobilised with a posterior splint or rigid boot until the patient is assessed by orthopaedics. Analgesics and anti-inflammatory medications are administered to control pain, and post-reduction X-rays are ordered to verify joint alignment.
Definitive Treatment
The definitive treatment depends on the stability of the reduction. Dislocations that remain stable after reduction can be managed with immobilisation for 6-8 weeks, avoiding weight-bearing.
In cases of instability, ligamentous damage, or associated fractures, surgery is required for internal fixation with plates and screws. Rehabilitation is essential to restore joint function and prevent complications such as post-traumatic osteoarthritis.
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