Emergency: requires immediate attention
Subtalar joint dislocation
Alerts and Notices
Synopsis
Emergent Care / Stabilization: Assess the patient for additional injuries and for pain control, and order x-rays to evaluate for concomitant fractures. Immediate orthopedic surgery consult is warranted as urgent reduction of the joint is necessary to avoid potential soft tissue or neurovascular compromise.Causes / typical injury mechanism: Subtalar joint dislocations are relatively rare injuries, typically caused by high-energy traumatic injury. Etiologies can include motor vehicle crashes, sport injuries, and falls from a height.
Classic history and presentation: Patients will present with a recent history of high-energy trauma and pain in the hindfoot, with a visible deformity of the ankle. Medial dislocations are more common than lateral dislocations; it is more frequently a closed injury, but open dislocations do occur given the traumatic nature of the injury.
Prevalence:
- Most commonly occurs in younger males with exposure to high-energy trauma
- Accounts for 1% of all dislocations
- Exposure to high-energy trauma
- Prior dislocation or joint hypermobility
- Medial dislocations are more common than lateral dislocations due to anatomic obstacles. Medial dislocations are associated with lower-energy mechanisms, and with basketball players.
- Lateral dislocations are higher energy, more often open injuries with, at times, extensive soft tissue damage.
- Concomitant fractures of talar bones are not uncommon at the talus and calcaneus in particular (periarticular fractures).
- Open versus closed
- Medial versus lateral dislocation (anterior and posterior dislocations are very rare)
Codes
ICD10CM:S93.316A – Dislocation of tarsal joint of unspecified foot, initial encounter
SNOMEDCT:
281506007 – Dislocation of subtalar joint
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Ankle sprain (high grade)
- Ankle fracture / dislocation
- Ankle fracture (unimalleolar, bimalleolar, or trimalleolar)
- Talus fracture
- Calcaneus fracture
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:10/18/2022
Last Updated:11/08/2022
Last Updated:11/08/2022
Emergency: requires immediate attention
Subtalar joint dislocation