ConditionInjuries & poisoning
Dislocated Ankle (Dislocation of the Ankle)
A dislocated ankle happens when the talus, the bone at the top of the foot, is forced out of its socket between the shin bone (tibia) and the outer leg bone (fibula). It takes major force, such as a fall from height, a car crash or a violent sports twist, and most cases also involve a broken bone. The foot looks visibly deformed. It is an emergency because the displaced bones can cut off blood flow to the foot. Prompt resetting, then usually surgery, gives the best result.
Also called: Ankle dislocation, tibiotalar dislocation, ankle fracture-dislocation, subtalar dislocation
At a glance
- What it is
- The ankle joint knocked out of position, usually with a fracture of the tibia, fibula or both.
- How it happens
- High-energy falls, car and motorcycle crashes, and severe sports injuries.
- Key signs
- Obvious deformity, severe pain, inability to bear weight, sometimes a numb or cold foot.
- How serious
- An emergency. The joint should be reset within hours to protect blood flow and skin.
- Recovery
- Bones take 6 to 12 weeks to heal; full recovery often takes 6 to 12 months.
When to get help
Call 911 or go to the ER
- An ankle that looks bent, twisted or out of place after an injury
- A cold, pale, blue or numb foot below the injury (call 911 or your local emergency number)
- Bone visible through the skin, or a wound over the injured ankle
- Skin stretched tight and white over a bony bump
See a doctor within a day or two
- Unable to take 4 steps on the injured ankle, with bony tenderness on either ankle knob
- Severe pain and swelling after a twist, even if the ankle looks straight
- Pain that keeps rising in a casted ankle, or tingling and tight swelling under the cast
Book a routine appointment
- Ongoing stiffness, swelling or giving way months after the injury has healed
First aid for a dislocated ankle
- Call 911 or your local emergency number if the ankle is deformed, the foot is cold or numb, or bone is visible.
- Do not try to push the ankle back into place yourself unless you are a trained medic in a remote setting.
- Keep the person still and lying down. Support the leg in the position found with pillows, rolled clothing or a padded splint.
- Cover any wound with a clean dressing. Do not push protruding bone back in.
- Apply a wrapped ice pack around, not on, the deformed area for up to 20 minutes.
- Do not give food or drink, as surgery or sedation may be needed soon.
- Remove shoes, socks and jewelry from the foot gently if possible, before swelling makes it difficult.
What a dislocated ankle is
The ankle (tibiotalar) joint is a hinge. The talus sits in a mortise formed by the end of the tibia (the inner ankle bone, or medial malleolus) and the end of the fibula (the outer ankle bone, or lateral malleolus), held in place by strong ligaments. Dislocating it requires those ligaments to tear or the bones to break.
Types
| Type | What happens | Notes |
|---|---|---|
| Fracture-dislocation | Talus displaced with fractures of one or more malleoli | By far the most common form |
| Pure ankle dislocation | Talus displaced without a fracture | Rare; seen in people with loose ligaments or extreme force |
| Subtalar dislocation | Joint below the talus dislocates, foot shifts inward or outward | Sometimes called a "basketball foot" when inward |
| Open dislocation | Bone or joint exposed through a skin wound | High infection risk; urgent surgery |
The foot most often displaces backward (posterior dislocation), but it can move forward, inward, outward or upward.
Symptoms
- sudden, severe pain at the moment of injury, often with a pop or crack
- an obviously misshapen ankle, with the foot pointing in an abnormal direction
- rapid swelling and later bruising
- unable to stand or put any weight on the leg
- numbness, tingling or a cold, pale foot if nerves or blood vessels are compressed
An ankle sprain also causes pain and swelling, but the ankle keeps its normal shape and you can usually bear some weight.
Diagnosis
In the ER, the team checks the pulses in the foot, capillary refill (how quickly color returns after pressing a toenail), sensation and toe movement. If circulation is compromised, the ankle may be reset before X-rays. X-rays from several angles confirm the dislocation and show any ankle fracture. A CT scan helps plan surgery for complex breaks. A further check of the pulses and X-rays follows every reduction.
Treatment
Reduction (resetting the joint)
Under sedation or strong pain relief, the doctor pulls gently on the heel and guides the talus back into its socket. This is done as quickly as possible, ideally within hours, to relieve pressure on the skin, nerves and arteries. The ankle is then held in a padded splint.
Surgery
Most fracture-dislocations are unstable and need open reduction and internal fixation (ORIF): plates and screws to hold the broken bones, and sometimes a screw across the syndesmosis (the joint between tibia and fibula). Surgery is often delayed several days until swelling settles. Open injuries need urgent washout, antibiotics and sometimes a temporary external frame. A pure dislocation with no fracture may be treated in a cast if the joint stays stable.
Pain control and clot prevention
Pain is managed with prescribed medicines plus elevation and ice. Because the leg will be immobilized, many people receive blood-thinning injections or tablets to lower the risk of deep vein thrombosis.
Recovery time
| Stage | Typical timing |
|---|---|
| Splint or cast, no weight bearing | First 6 weeks |
| Walking boot, gradual weight bearing | Weeks 6 to 12 |
| Physical therapy for motion, strength and balance | From about week 6 for several months |
| Return to driving (right ankle) | Usually 9 to 12 weeks, when you can brake hard safely |
| Return to sport | 4 to 6 months or longer |
| Final recovery of function | 6 to 12 months; some stiffness may persist |
Smoking, diabetes and early weight bearing against advice all raise the risk of the bones failing to heal.
Complications
- Damage to blood vessels or nerves in the foot
- Compartment syndrome: dangerous pressure build-up in the leg muscles
- Skin breakdown and infection, especially after open injuries
- Post-traumatic arthritis: ankle arthritis in the years after the injury is common after fracture-dislocations
- Stiffness and chronic ankle instability
- Blood clots in the leg
- Avascular necrosis of the talus, mainly after subtalar or talus injuries
Frequently asked questions
Can you walk on a dislocated ankle?
No. A dislocated ankle is extremely painful and unstable, and trying to walk can damage the skin, nerves and blood vessels further. Keep the leg still and supported until emergency help arrives.
How long does a dislocated ankle take to heal?
The bones and ligaments usually heal in 6 to 12 weeks, but regaining strength, motion and balance takes much longer. Most people return to normal daily activities in 3 to 6 months and sport in 4 to 6 months or more. Full recovery can take a year.
Is a dislocated ankle worse than a broken ankle?
A dislocation is usually the more serious injury, because it nearly always includes a fracture and also threatens blood supply to the foot. It needs urgent resetting and usually surgery, while many simple ankle fractures heal in a boot or cast.
Can a dislocated ankle pop back in by itself?
It occasionally relocates on its own, but the ligaments and bones have still been badly injured. Anyone whose ankle looked deformed, even briefly, should be examined and X-rayed the same day.
Will I get arthritis after a dislocated ankle?
The risk is higher than after a simple sprain or minor fracture, particularly if the joint surface was damaged. Accurate surgical repair and physical therapy reduce the risk, but some people develop ankle arthritis years later.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Ankle fractures (broken ankle)
- NHS: Dislocated joints
- MedlinePlus: Dislocation
- American College of Surgeons: Advanced Trauma Life Support (ATLS) principles for extremity trauma
- Merck Manual Professional Version: Ankle fractures and dislocations