Foot dislocation: symptoms, first aid, treatment and rehabilitation

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The legs support the body, and the feet support the legs. Often, athletes underestimate the importance of healthy feet and ankles in achieving optimal athletic performance, not to mention overall health and wellness. The most unpleasant thing is that even minor injuries to the foot and ankle can have very bad long-term consequences for health in the future. How foot injuries occur, what a foot dislocation is and how to recognize, prevent and treat it - we will tell you in this article.

Foot structure

The foot is a complex anatomical formation. It is based on a bone frame represented by the talus, calcaneus, navicular, cuboid and sphenoid bones (tarsal complex), metatarsal bones and fingers.

Bone base

The talus serves as a kind of “adapter” between the foot and the lower leg, due to its shape providing mobility to the ankle joint. It lies directly on the heel bone.
The calcaneus is the largest bone that forms the foot. It is also an important bony landmark and attachment point for the muscle tendons and aponeurosis of the foot. Functionally, it performs a supporting function when walking. In front it comes into contact with the cuboid bone.
The cuboid bone forms the lateral edge of the tarsal part of the foot; the 3rd and 4th metatarsals are directly adjacent to it. With its medial edge, the described bone is in contact with the scaphoid bone.
The navicular bone forms the medial part of the tarsal region of the foot. Lies anterior and medial to the calcaneus. In front, the scaphoid bone is in contact with the sphenoid bones - lateral, medial and medial. Together they form a bony base for attaching the metatarsal bones.
Metatarsal bones are related in shape to the so-called tubular bones. On the one hand, they are motionlessly connected to the bones of the tarsus, on the other, they form movable joints with the toes.

There are five toes, four of them (from the second to the fifth) have three short phalanges, the first - only two. Looking ahead, the toes perform an important function in the walking pattern: the final stage of pushing the foot off the ground is possible only thanks to the first and second toes.

Ligamentous apparatus

The listed bones are strengthened by the ligamentous apparatus; they form the following joints among themselves:

Subtalar – between the talus and calcaneus bones. It is easily injured when the ankle ligaments are sprained, with the formation of a subluxation.
Talon-calcaneonavicular - around the axis of this joint it is possible to perform pronation and supination of the foot.
In addition, it is important to note the tarsometatarsal, intermetatarsal and interphalangeal joints of the foot.

The most significant for the formation of the correct arch of the leg are the muscles located on the plantar side of the leg. They are divided into three groups:

external;
internal;
average.

The first group serves the little finger, the second group – the thumb (responsible for flexion and adduction). The middle muscle group is responsible for flexing the second, third and fourth toes.

Biomechanically, the foot is designed in such a way that, with proper muscle tone, its plantar surface forms several arches:

external longitudinal arch - passes through a mentally drawn line between the calcaneal tubercle and the distal head of the fifth phalangeal bone;
internal longitudinal arch - passes through a mentally drawn line between the calcaneal tubercle and the distal head of the first metatarsal bone;
transverse longitudinal arch - passes through a mentally drawn line between the distal heads of the first and fifth metatarsal bones.

In addition to the muscles, the powerful plantar aponeurosis, mentioned above, takes part in the formation of such a structure.

Types of foot dislocations

Foot sprains can be divided into three types:

Subtalar foot dislocations

With this type of foot injury, the talus remains in place, and the adjacent calcaneus, navicular and cuboid bones seem to diverge. In this case, significant trauma to the soft tissues of the joint occurs, with damage to the blood vessels. The joint cavity and periarticular tissues are filled with an extensive hematoma. This leads to significant swelling, pain and, which is the most dangerous factor, to disruption of blood delivery to the limb. The latter circumstance can serve as a trigger for the development of gangrene of the foot.

Dislocation of the transverse tarsal joint

This type of foot injury occurs due to direct traumatic impact. The foot has a characteristic appearance - it is turned inwards, the skin on the back of the foot is stretched. When palpating the joint, the scaphoid bone, displaced inwards, can be clearly felt. The swelling is as pronounced as in the previous case.

Dislocation of the metatarsal joint

A fairly rare foot injury. Most often occurs with direct trauma to the front edge of the foot. The most likely mechanism of injury is landing from an elevated position on the balls of your feet. In this case, the first or fifth phalangeal bones can move in isolation, or all five at once. Clinically, there is a step-like deformation of the foot, swelling, and the inability to step on the foot. Voluntary movements of the toes are significantly difficult.

Sprained toes

The most common dislocation occurs in the metatarsophalangeal joint of the first toe. In this case, the finger moves inward or outward, with simultaneous flexion. The injury is accompanied by pain, significant pain when trying to push off the ground with the injured leg. Wearing shoes is difficult, often impossible.

Dislocation of the talus of the foot

Isolated dislocation of the talus in its pure form is rare. The talus can move in all directions (but more often outward) and even rotate around its axis. To get this dislocation, it is necessary to break the ligaments that fix it to the lower leg, to the heel and navicular bones. These tears occur either with forced inward (pronation) or outward (supination) rotation, or with concomitant dorsiflexion or plantar flexion of the foot. The predominant direction of force also determines the displacement of the talus to one side or the other. Often the neck of the talus is broken. Reduction of pure dislocations of the talus is possible by traction of the foot with the knee bent and direct pressure on the protruding bone. In difficult cases, they resort to the bloody installation of the dislocated talus in place or even to its removal.

A subtalar dislocation occurs inwardly or outwardly when the forefoot is strongly rotated inward (pronation) or outward (supination), while it is fixed on the ground. In this case, the connections of the talocalcaneal and talonavicular joints are torn. A more dramatic separation occurs at the talonavicular joint. With a sharp inward rotation (pronation) of the fixed forefoot, an inward rotational movement of the tibia results in an outward displacement of the navicular bone with the forefoot. Under the same conditions, a sharp twisting of the foot outward with outward rotation (rotation) of the tibia results in an inward displacement of the navicular bone and foot. It is easy to recognize a subtalar dislocation medially by this characteristic position of the foot. In this case, it is possible to perform flexion and extension in the ankle joint.

Procedure for reducing a dislocated foot.

Extremely rare forms of subtalar dislocation backwards or forwards require fractures to occur.

Reduction of pure subtalar dislocations under anesthesia is easy due to the extent of the ruptures of the articular joints of the foot. Fixation with an immobilizing bandage for 4-5 weeks and approximately the same amount of time, rehabilitation and physical therapy restore almost normal foot function in 2-3 months.

Signs and symptoms of a dislocation

The main symptoms of a sprained foot are:

Pain that occurs suddenly, immediately after exposure to a traumatic factor on the foot. However, after the cessation of exposure, the pain remains. It gets worse when you try to lean on the injured limb.
Edema . The area of the damaged joint increases in volume, the skin becomes stretched. There is a feeling of the joint bursting from the inside. This circumstance is associated with concomitant injury to soft tissue formations, in particular blood vessels.
Loss of function . It is impossible to make any voluntary movement in the damaged joint; attempting to do so brings significant pain.
Forced position of the foot - part of the foot or the entire foot is in an unnatural position.

Be careful and attentive! It is impossible to distinguish a dislocated foot from a sprain or fracture of the foot visually without an X-ray machine.

First aid for sprain

First aid for a sprained foot consists of the following algorithm of actions:

The victim must be placed on a comfortable, flat surface.
Next, you should give the injured limb an elevated position (the foot should be above the knee and hip joints), placing a pillow, jacket or any suitable means under it.
To reduce post-traumatic swelling, you need to cool the injury site. Ice or any product frozen in the freezer (for example, a pack of dumplings) is suitable for this.
If the skin is damaged, it is necessary to apply an aseptic bandage to the wound.
After all the actions described above, you need to deliver the victim as soon as possible to a medical facility where there is a traumatologist and an X-ray machine.

Dislocated toes

More often we are dealing with a dislocation of the big toe in the dorsal direction. Signs of such an injury are deformation of the axis of the finger, its shortening and local pain. After administering local anesthesia, the doctor will move the joint back into place. To secure the result, an adhesive bandage is sufficient.

To ensure that your feet become healthy again and the injury does not lead to unpleasant consequences in the future, you need to be treated by competent orthopedic traumatologists. The doctors of the GarantKlinik medical center have high-tech equipment for performing operations and have the necessary experience and qualifications to manage patients with foot dislocations and other injuries, and our prices for traumatological services make them accessible to the majority of the population.

Treatment of dislocation

Treatment for a dislocation involves straightening the leg and returning it to its natural position. Reduction can be closed, without surgical intervention, or open, that is, through a surgical incision.

It is impossible to give any specific advice on what and how to treat a dislocated foot at home, since this cannot be done without the help of an experienced traumatologist. After adjusting the sprain, he can give you some recommendations on what to do if you have a sprained foot to quickly restore motor function.

After the reduction procedures, a fixing bandage is applied for a period of four weeks to two months. It should not be surprising that when fixing the lower leg, the splint will be applied to the lower third of the thigh - with fixation of the knee joint. This is a necessary condition, since the process of walking with a stationary ankle is very dangerous for the knee joint.

Dislocation of the Lisfranc joint

The Lisfranc joint connects the tarsus and metatarsus bones. It is possible to dislocate one metatarsal bone or all five at once. A distinction is made between divergent and homolateral dislocation: in the first case, the first metatarsal bone moves to one side, and the other four to the other, and in the second case, all the bones move inward.

Symptoms of a foot dislocation in the Lisfranc joint are shortening and flattening of the foot, it is somewhat turned inward, and a bony protrusion in the form of a step is identified in the forefoot. The patient can move his fingers, but the supporting function of the foot is almost impossible.

Such a dislocation requires surgical intervention. Surgeons carefully reduce the metatarsal bones and secure their position using Kirschner wires and screws, temporarily immobilizing the Lisfranc joint. Closed reduction is rarely effective. For patients with chronic foot dislocation, we recommend wearing orthopedic shoes.