An Adult Male With a Recreational Ankle Injury
Article Outline
A previously healthy 51-year-old man presented to the emergency department after jumping to “spike” a volleyball and landing on an inverted right foot. At the scene, the patient had experienced immediate pain and a lateral deformity of his right ankle. He was unable to bear weight (Figure 1, Figure 2).
Figure 1.
Lateral radiograph taken shortly after arrival and prior to reduction attempts.
Figure 2.
Radiograph taken shortly after arrival and prior to reduction attempts.
Diagnosis
Medial subtalar (talocalcaneal) dislocation. Subtalar dislocation is an uncommon injury in which the talocalcaneal and talonavicular joints are dislocated simultaneously, without a fracture of the neck of the talus (Figure 3).1 The injury is usually a result of a high-energy mechanism, such as a motor vehicle crash or a fall from height. However, this injury has been reported during low-energy inversion injuries such as the one described above. The talocalcaneal and talonavicular ligaments are responsible for transmitting weight between the foot and the ankle and are stressed when a forceful inversion injury causes the talus to pivot on the sustentaculum tali, leading to a medial subtalar dislocation (Figure 4). Failure to reduce properly may result in damage to the talocalcaneal and talonavicular ligaments. Appropriate reduction procedure includes adequate sedation, providing in-line traction, and initially maintaining the foot in plantar flexion. Abduction should then be applied to the foot while everting and dorsiflexing the foot.2
Figure 3.
Illustration (corresponding to radiograph seen in figure 1). Also depicted are the medial and posterior talocalcaneal ligaments.
Copyrighted and used with permission of Mayo Foundation for Medical Education and Research.
Figure 4.
Illustration (corresponding to radiograph seen in figure 2).
Copyrighted and used with permission of Mayo Foundation for Medical Education and Research.
References
For the diagnosis and teaching points, see page 521.
To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com.
PII: S0196-0644(09)01262-1
doi:10.1016/j.annemergmed.2009.07.017
© 2009 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
