Dislocation of the Foot
A serious orthopedic injury where bones in the foot are forced out of their normal position, requiring immediate medical attention
Quick Facts
- Type: Orthopedic Injury
- ICD-10: S93.3
- Emergency: Yes
- Recovery: 6-12 weeks
Overview
Foot dislocation is a severe injury that occurs when the bones in the foot are forced out of their normal anatomical position. This can involve any of the 26 bones and 33 joints in the foot, though certain areas are more commonly affected than others. The injury disrupts the normal alignment of bones and can damage surrounding ligaments, tendons, blood vessels, and nerves. Foot dislocations represent approximately 2% of all dislocations and often occur in combination with fractures.
The foot's complex anatomy includes multiple joints that can be affected by dislocation. The most common sites include the Lisfranc joint (tarsometatarsal), the subtalar joint, and the metatarsophalangeal joints (especially the great toe). Each type of dislocation has specific mechanisms of injury and treatment considerations. Lisfranc injuries, for example, can be particularly serious and are sometimes missed on initial evaluation, leading to long-term complications if not properly treated.
Foot dislocations are considered orthopedic emergencies requiring immediate medical attention. The injury can compromise blood flow and nerve function to the foot, potentially leading to permanent damage if not promptly reduced (put back in place). Recovery typically involves a period of immobilization followed by rehabilitation, with the timeline varying depending on the severity and location of the dislocation. While many patients recover fully with appropriate treatment, some may experience long-term complications such as arthritis, chronic pain, or instability.
Symptoms
Foot dislocation presents with dramatic symptoms that typically develop immediately after injury.
Primary Symptoms
Associated Symptoms
- Immediate and severe pain that worsens with movement
- Obvious deformity or abnormal foot position
- Rapid onset of swelling and bruising
- Inability to move the affected joint
- Numbness or tingling in the foot or toes
- Skin tenting over displaced bones
- Cool or pale foot (if blood flow compromised)
- Grinding or crepitus sensation
Systemic Symptoms
- Nausea or vomiting from severe pain
- Lightheadedness or fainting
- Shock symptoms in severe cases
- Anxiety or distress
Warning Signs of Complications
- Loss of pulse in the foot
- Complete numbness below injury
- Foot turning blue or white
- Severe, uncontrolled bleeding
- Open wound with bone visible
- Weakness in other extremities (if multiple trauma)
Causes
Foot dislocations result from forces that exceed the strength of the ligaments holding bones in place.
High-Energy Trauma
Motor Vehicle Accidents
- Direct impact to foot
- Foot trapped under pedals
- Crushing injuries
- High-speed collisions
Falls from Height
- Landing on twisted foot
- Direct axial loading
- Hyperextension injuries
- Construction accidents
Sports Injuries
- Contact sports: Football, rugby tackles
- Twisting injuries: Basketball, soccer
- Gymnastics: Landing errors
- Dance: Pointe work complications
- Martial arts: Kicking injuries
- Skiing: Boot-related injuries
Specific Mechanisms by Location
Lisfranc Dislocation
- Twisting fall with foot fixed
- Direct blow to midfoot
- Missing step with forefoot fixed
- Equestrian accidents (foot caught in stirrup)
Subtalar Dislocation
- High-energy trauma
- Inversion or eversion forces
- Basketball landing injuries
- Motor vehicle accidents
Metatarsophalangeal Dislocation
- Hyperextension of toes
- Stubbing injuries
- Barefoot activities
- Dance or gymnastics
Contributing Factors
- Previous foot injuries
- Ligament laxity
- Connective tissue disorders
- Neuromuscular conditions
- Bone weakening conditions
Risk Factors
Several factors increase the risk of foot dislocation:
Activity-Related Risks
- High-impact sports: Football, basketball, soccer
- Dance and gymnastics: Repetitive stress, extreme positions
- Military training: Obstacle courses, combat training
- Construction work: Falls, heavy equipment
- Rock climbing: Falls, foot entrapment
Medical Conditions
- Ehlers-Danlos syndrome: Joint hypermobility
- Marfan syndrome: Connective tissue weakness
- Rheumatoid arthritis: Joint damage
- Diabetes: Neuropathy, Charcot foot
- Osteoporosis: Weakened bones
- Previous dislocations: Ligament damage
Environmental Factors
- Uneven surfaces
- Poor lighting conditions
- Inappropriate footwear
- Wet or slippery surfaces
- Cluttered walkways
Demographic Factors
- Age: Young adults (sports), elderly (falls)
- Gender: Males more common (high-risk activities)
- Occupation: Manual laborers, athletes
- Previous injuries: Weakened structures
Diagnosis
Prompt and accurate diagnosis is crucial for proper treatment and preventing complications.
Initial Assessment
Clinical Examination
- Visual inspection for deformity
- Assessment of skin integrity
- Palpation for tenderness and crepitus
- Neurovascular examination
- Range of motion testing (if tolerated)
- Comparison with uninjured foot
Neurovascular Assessment
- Pulses: Dorsalis pedis, posterior tibial
- Capillary refill: Should be <2 seconds
- Sensation: Light touch, pinprick
- Motor function: Toe movement if possible
- Temperature: Compare to other foot
Imaging Studies
X-rays (First Line)
- AP, lateral, and oblique views
- Weight-bearing views if possible
- Comparison views of other foot
- Stress views for ligament injury
CT Scan
- Complex dislocations
- Associated fractures
- Surgical planning
- 3D reconstruction helpful
MRI
- Soft tissue evaluation
- Ligament integrity
- Cartilage damage
- Occult fractures
Classification Systems
- Lisfranc injuries: Homolateral, divergent, isolated
- Subtalar: Medial, lateral, anterior, posterior
- Severity: Simple vs complex (with fracture)
- Open vs closed: Skin integrity
Treatment Options
Treatment depends on the location, severity, and associated injuries.
Emergency Management
Initial Stabilization
- Immobilization: Splint in position found
- Pain control: IV analgesics
- Ice application: Reduce swelling
- Elevation: Above heart level
- NPO status: If surgery anticipated
Closed Reduction
Procedure
- Conscious sedation or anesthesia
- Gentle traction and manipulation
- Reversal of injury mechanism
- Immediate X-ray confirmation
- Neurovascular reassessment
Post-Reduction Care
- Immobilization in cast or splint
- Non-weight bearing status
- Elevation and ice
- Close follow-up
Surgical Treatment
Indications
- Failed closed reduction
- Open dislocations
- Associated fractures
- Neurovascular compromise
- Chronic instability
Surgical Options
- Open reduction: Direct visualization
- Internal fixation: Pins, screws, plates
- Ligament repair: Primary or reconstruction
- External fixation: Severe soft tissue injury
- Arthrodesis: For chronic cases
Rehabilitation
Phase 1: Protection (0-6 weeks)
- Non-weight bearing
- Cast or boot immobilization
- Toe exercises if permitted
- Upper body conditioning
Phase 2: Mobilization (6-12 weeks)
- Progressive weight bearing
- Range of motion exercises
- Pool therapy
- Gentle strengthening
Phase 3: Strengthening (3-6 months)
- Full weight bearing
- Balance training
- Sport-specific exercises
- Return to activity protocol
Prevention
While not all foot dislocations can be prevented, risk can be reduced through various measures:
Footwear and Equipment
- Wear appropriate shoes for activities
- Ensure proper fit and support
- Replace worn-out athletic shoes
- Use protective gear in contact sports
- Consider ankle braces for high-risk activities
Environmental Safety
- Keep walkways clear and well-lit
- Fix uneven surfaces
- Use handrails on stairs
- Install grab bars in bathrooms
- Remove tripping hazards
Physical Conditioning
- Strengthen foot and ankle muscles
- Improve balance and proprioception
- Maintain flexibility
- Gradual activity progression
- Proper warm-up before sports
Activity Modifications
- Learn proper techniques for sports
- Avoid activities when fatigued
- Use caution on uneven terrain
- Modify activities based on conditions
- Listen to body warning signs
When to See a Doctor
Foot dislocation is always a medical emergency requiring immediate professional care:
Call 911 Immediately For
- Obvious foot deformity
- Severe pain with inability to move foot
- Open wound with visible bone
- Foot turning blue, white, or cold
- Complete numbness in foot
- No pulse in foot
- Uncontrolled bleeding
Emergency Department Care Needed
- Suspected dislocation even if mild
- Significant swelling after injury
- Unable to bear any weight
- Foot appears misaligned
- Severe pain not relieved by rest
While Waiting for Help
- Do NOT attempt to relocate the joint
- Immobilize foot in position found
- Apply ice wrapped in cloth
- Elevate if possible
- Remove tight jewelry or shoes
- Monitor circulation and sensation
Follow-up Care Important For
- Persistent pain after treatment
- Numbness or tingling
- Signs of infection
- Difficulty with rehabilitation
- Recurrent instability
Frequently Asked Questions
Recovery time varies depending on severity and location. Simple dislocations may heal in 6-8 weeks with proper treatment, while complex injuries involving surgery can take 3-6 months or longer. Full recovery including return to sports may take 6-12 months. Rehabilitation is crucial for optimal outcomes.
No, foot dislocations cannot heal properly without medical treatment. The bones must be relocated (reduced) by a medical professional to restore normal anatomy. Attempting to "walk it off" or waiting for it to heal naturally can result in permanent damage, chronic pain, arthritis, and disability.
A sprain involves stretching or tearing of ligaments while bones remain in place. A dislocation means bones have completely moved out of their normal position. Dislocations are more severe, often requiring reduction and longer recovery. Both injuries can occur together, and imaging is needed to distinguish them.
Not always. Many foot dislocations can be treated with closed reduction (manipulation without surgery) followed by immobilization. Surgery is needed for open dislocations, failed closed reduction, associated fractures, or ligament damage requiring repair. Your orthopedic surgeon will determine the best approach based on imaging and examination.
Yes, several measures can reduce recurrence risk: complete your rehabilitation program, strengthen foot and ankle muscles, improve balance and proprioception, wear appropriate supportive footwear, use protective bracing if recommended, and modify high-risk activities. Some people may have increased risk due to ligament laxity.
References
- Gotha HE, Lareau CR, Fellars TA. Lisfranc Fracture-Dislocations: Current Concepts. Clin Podiatr Med Surg. 2018;35(4):423-434.
- Bibbo C, Anderson RB, Davis WH. Injury characteristics and the clinical outcome of subtalar dislocations: a clinical and radiographic analysis of 25 cases. Foot Ankle Int. 2003;24(2):158-163.
- Perugia D, Basile A, Massoni C, et al. Conservative treatment of subtalar dislocations. Int Orthop. 2002;26(1):56-60.
- Weatherford B. Lisfranc (Midfoot) Injury. OrthoInfo - American Academy of Orthopaedic Surgeons. 2020.
- Court-Brown CM, Heckman JD, McQueen MM, et al., eds. Rockwood and Green's Fractures in Adults. 8th ed. Philadelphia: Wolters Kluwer; 2015.