Dislocation of the Foot

What to do right now

1. Call 911 or your local emergency number for an obviously deformed foot, an open wound over the injury, or a cold or numb foot. Otherwise go to an ER.
2. Do not try to push or pull the joint back in. You can damage blood vessels, nerves and cartilage.
3. Keep the foot still. Support it with pillows or a rolled blanket in the position you found it.
4. Elevate it above heart level if you can do so without moving the joint.
5. Apply ice wrapped in a cloth for 15 to 20 minutes.
6. Cover any wound with a clean dressing.
7. Do not eat or drink in case you need sedation or surgery.
8. Remove rings, socks and shoes gently if swelling allows, before the foot swells more.

Types of foot dislocation

Lisfranc (midfoot) injury

The Lisfranc joint complex is where the long bones of the foot (metatarsals) meet the midfoot bones (tarsals). It is held together by strong ligaments. It can be injured by a high-energy crash or by a simple twist on a pointed foot, for example missing a step, a football player landing on another's heel, or a foot caught in a stirrup. Signs include midfoot pain and swelling, inability to stand on tiptoe and bruising on the sole. Lisfranc injuries are often mistaken for a sprain and missed on routine X-rays, which is why weight-bearing X-rays or CT are used.

Subtalar and talus dislocations

The talus is the bone that connects the leg to the foot. In a subtalar dislocation, the foot dislocates beneath it, often from a fall from height or a basketball landing. The foot points sharply inward or outward. A total talus dislocation, where the bone is forced out of both ankle and subtalar joints, is rare, serious, and often an open injury.

Chopart (mid-tarsal) dislocation

The joints across the middle of the foot between the hindfoot and midfoot. Usually from high-energy injury and frequently associated with fractures.

Toe dislocations

The most common foot dislocations, usually from stubbing or jamming a toe. The toe looks crooked or shortened. Most can be put back in the ER with local anesthetic and then buddy-taped. The big toe joint may need more care, because it carries much of your weight when you push off.

Symptoms of a dislocated foot

• Sudden severe pain at the time of injury
• A foot or toe that looks misshapen, twisted, shortened or out of line
• Rapid swelling and bruising, including bruising on the sole
• Being unable to walk or put weight on the foot
• Numbness, tingling or coldness if a nerve or artery is stretched
• A popping sensation at the time of injury

Diagnosis

The doctor checks the pulse in the foot, color, warmth, sensation and toe movement to look for nerve and blood vessel damage, then examines the skin for wounds. Imaging includes:

• X-rays from several angles, and weight-bearing X-rays when Lisfranc injury is suspected but the first images look normal
• CT scan to show small fractures and joint alignment, especially before surgery
• MRI to show torn ligaments in subtle Lisfranc injuries

How a dislocated foot is fixed

Reduction

The dislocated bones are put back into place as soon as possible, usually under sedation or anesthesia. Fast reduction reduces pressure on the skin, nerves and blood vessels. Some dislocations cannot be reduced without an operation because tendons or bone fragments block the joint.

After reduction

• Stable injuries: a splint, then a non-weight-bearing cast or boot for about 6 weeks.
• Unstable injuries (most Lisfranc and many hindfoot injuries): surgery with screws, plates or wires to hold the bones in line while the ligaments heal. Some severe Lisfranc injuries are treated by fusing the joints.
• Open injuries: urgent surgical washout and antibiotics.
• Toe dislocations: buddy-taping and a stiff-soled shoe for 3 to 6 weeks.

Rehabilitation

Physical therapy restores range of motion, strength, balance and walking. Return to full sport usually takes 6 to 12 months for midfoot and hindfoot injuries. Hardware may be removed after several months.

Complications

• Compartment syndrome: dangerous pressure build-up in the foot muscles, needing emergency surgery.
• Nerve and artery damage: causing numbness or poor blood supply. See vascular injury.
• Skin breakdown over displaced bones.
• Post-traumatic arthritis: stiffness and pain years later, common after Lisfranc and subtalar injuries.
• Avascular necrosis of the talus, where the bone loses its blood supply.
• Chronic instability or flattening of the arch if ligaments do not heal well.

Dislocated foot vs sprain vs fracture

A bad ankle sprain and a subtle Lisfranc injury can look alike. Any midfoot injury where you cannot bear weight needs X-rays.

Frequently asked questions

What happens if you have a dislocated foot?

The bones of a foot joint slip out of position, tearing ligaments and often breaking bone. You will have severe pain, swelling and usually a deformed foot that cannot take weight. It needs emergency reduction, imaging, and often surgery to hold the bones in place while they heal.

How do you fix a dislocated foot?

Do not try to fix it yourself. In hospital, a doctor gives pain relief or sedation and gently manipulates the bones back into place. Most midfoot and hindfoot dislocations then need a cast or surgery with screws or plates, followed by weeks of no weight-bearing and physical therapy.

Can you walk on a dislocated foot?

Usually not. A dislocated foot is extremely painful and unstable. Some subtle Lisfranc injuries let people limp, which is why they are missed. If you cannot stand on tiptoe or have bruising on the sole after an injury, get an X-ray.

How long does a dislocated foot take to heal?

A dislocated toe usually heals in 3 to 6 weeks. A Lisfranc or subtalar dislocation typically needs 6 to 12 weeks without full weight-bearing, and full recovery including return to sport takes 6 to 12 months. Some people have lasting stiffness or arthritis.

What are the symptoms of a dislocated foot?

Severe pain, a foot or toe that looks out of shape, rapid swelling, bruising (often on the sole), inability to walk, and sometimes numbness, tingling or a cold foot. Any of these after a fall, crash or twisting injury needs urgent assessment.