About dislocated ankle (ankle dislocation)

What is dislocated ankle (ankle dislocation)?

Dislocated ankle facts

  • An isolated dislocated ankle is a rare injury. Usually, there is an associated fracture of the bones that make up the ankle.
  • The ankle dislocates as a result of a fall, motor-vehicle crash, or sporting injury.
  • In addition to the bony injury, there can be damage to blood vessels, nerves, and skin.
  • The diagnosis is often made clinically.
  • The emergency treatment is to reduce the dislocation as soon as possible and then splint the ankle to prevent further damage.
  • Orthopedic or podiatric consultation is usually required since surgery may be required depending upon the patient's situation.
  • Arthritis is a common complication of an ankle dislocation.
  • Most dislocated ankles result from accidental injury and are difficult to prevent.

What is a dislocated ankle?

The ankle is a hinge joint that connects the lower leg to the foot. The tibia and fibula of the leg come into contact with the talus of the foot, forming the ankle mortise. The majority of the weight bearing in the ankle occurs between the tibia and talus. While the shape of the mortise helps align the ankle joint, the surrounding ligaments are very important in providing stability.

A dislocated joint describes the situation where the bones that come together to form a joint no longer maintain that normal relationship. In the ankle, it means that the tibia and talus no longer maintain their normal anatomic relationship.

Most commonly, a dislocated ankle is associated with fractures of the distal ends of the tibia and fibula (called the malleolus) in association with damage to the ligaments that help support the ankle joint. Less commonly, isolated ligament injuries can result in the dislocation.

What are the symptoms for dislocated ankle (ankle dislocation)?

Dislocations are painful, and there is usually obvious deformity of the ankle joint. It may be very difficult or impossible to stand or walk.

  • If the nerves that run across the ankle joint are damaged or inflamed, there can be Numbness and tingling of the foot.
  • There is almost immediate Swelling of the ankle joint area and ecchymosis (bruising) may occur quickly.
  • Depending upon the mechanism of injury, there can be associated other injuries to the foot, knee, or spine.

What are the causes for dislocated ankle (ankle dislocation)?

Ankle dislocations do not happen spontaneously but are a result of a trauma. Forces are placed on the ankle that causes the bones to fracture or the ligaments to tear, resulting in the dislocation injury.

The ankle is an inherently stable joint and the direction of the dislocation depends upon the position of the foot and where the force arises. Ankle dislocations are more often associated with fractures of the bones that make up the joint.

Common causes of dislocations include:

  • falls,
  • motor-vehicle crashes, and
  • sports injuries.

What are the treatments for dislocated ankle (ankle dislocation)?

Once the initial evaluation is complete, the goal of emergency treatment of an ankle dislocation begins with trying to reduce the injury, returning the bones as close as possible to their normal anatomic position. Often the bones will fall back into place with gentle traction. Sometimes medication is required to sedate the patient and help the surrounding muscles relax.

If there is evidence that the blood and nerve supply to the foot are in jeopardy or if the skin is tented and stretched and the clinical diagnosis of ankle dislocation is made, attempts to reduce the ankle joint may be necessary even before an X-ray is taken to preserve nerve and blood vessel function.

Once the ankle is reduced, examination of the blood and nerve supply to the foot is repeated and a temporary plaster or fiberglass splint is placed.

An orthopedic or podiatric consultation may need to occur emergently, especially if there are unstable fractures present, if nerve or artery damage exists, or if the ankle cannot be reduced and an emergency operation is needed.

Even if the ankle dislocation is reduced, many times an operation is eventually required to stabilize the structures that were damaged. The decision as to whether surgery is required and what type of surgery might be needed is individualized for each patient and their situation.

After the initial treatment is complete, whether or not surgery is required, rehabilitation may take six to 12 weeks before returning the patient to their pre-injury activities.

What are the risk factors for dislocated ankle (ankle dislocation)?

The most common type of ankle dislocation is the posterior dislocation, where the talus moves backward in relation to the tibia. For this to occur, the foot needs to be plantarflexed (the toes are pointing downward) when the injury occurs. The ankle is either forced inward from the outside (inversion) or outward from the inside (eversion), tearing the ligaments and tissues that hold the ankle stable.

  • Anterior dislocations, where the talus is pushed forward, occur when the foot is fixed or dorsiflexed (where the toes are pointed upward). The force from in front of the foot pushes the tibia backward.
  • Lateral dislocations occur when the ankle is twisted, either inverted or everted, but there are always fractures associated with either the medial or lateral malleolus or both.
  • Superior dislocation describes where the talus is jammed upward, into the space between the tibia and fibula, as a result of an axial loading injury and is called a pilon injury. This may be due to landing on one's feet from a fall or from being in a car wreck where the foot is held firmly against the brake pedal.

Is there a cure/medications for dislocated ankle (ankle dislocation)?

There is no cure for dislocated ankle (ankle dislocation), but there are treatments that can help ease the pain and ensure the best recovery.

1. Rest: Resting your ankle is important to allow the bone and soft tissues to heal. A doctor will likely recommend wearing a walking boot and avoiding any weight-bearing activities until your doctor gives you the go-ahead.

2. Ice: Applying ice to your ankle may help reduce swelling and pain. You should apply ice for 15 minutes at a time, several times throughout the day.

3. Compression: The presence of swelling in your ankle can cause pain and discomfort while walking around on it or trying to put on shoes or socks—a compression wrap or sleeve can help alleviate both issues by reducing swelling while also providing support for your ankle joint as you move around during recovery time periods.

4. Elevation: Keeping your foot elevated above heart level will help reduce swelling and increase blood flow back into circulation when sitting still for longer periods at a time (such as overnight).

Some of the medications used in treating ankle dislocation include:

1. NSAIDs, or non-steroidal anti-inflammatory drugs, are a type of medication that can help reduce your pain and swelling. NSAIDs include ibuprofen (Advil) and naproxen (Aleve).

2. Pain medications, such as acetaminophen (Tylenol), may also be prescribed to help relieve your pain.

3. Surgery may be needed to relocate the bones in your ankle if they don’t go back into place on their own, or if the joint is unstable (meaning it keeps popping out of place).

Pain and swelling around your ankle,Swelling, bruising and tenderness on the inside of the ankle,A feeling that the ankle is out of place and may be dislocated,Difficulty moving your ankle joint and foot,Inability to put any weight on it
Fall from height,Twisting of ankle (inversion),Direct blow to the front of ankle,Hyperflexion of ankle, causing a fracture-dislocation of the joint when a person is running fast and suddenly stops,Hyper-extension and inversion causes avulsion fracture or ligament rupture
Ibuprofen,Naproxen sodium,Acetaminophen,Aspirin

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