What is Subtalar Dislocation

Subtalar ankle dislocation is an injury in which some of the bones that form the ankle joint are forcefully moved out of place (displaced). This type of dislocation occurs between the upper ankle bone (talus), the heel bone (calcaneus), and the front foot bone (navicular).

Subtalar dislocation is usually sideways, toward the inner edge (medial dislocation) or the outer edge (lateral dislocation) of the ankle. Medial dislocation occurs if your foot is forcefully turned down and inward.

This is the most common type. Lateral subtalar dislocation occurs if your foot is forcefully pushed up and outward.

Subtalar dislocation may also include bone fractures and tears in the strong bands of tissue that connect bones together (ligaments).

What are the causes?

This condition is caused by a forceful injury to the ankle. This can happen if you:

• Fall from a high height or land a jump with your foot in a twisted position.
• Twist your foot with impact, such as sliding into a base or getting tackled with your foot in place.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Playing sports that involve high impact on the feet. These include:
  • Basketball.
  • Football.
  • Baseball.
  • Gymnastics.
  • Parkour.
• Being a male who is 30–40 years of age.
• Being born with more looseness (laxity) in your ligaments.
• Having weak lower leg muscles.
• Having had frequent ankle sprains.

What are the signs or symptoms?

Symptoms of this condition include:

• Severe pain.
• Obvious deformity of the foot and ankle.
• Swelling.
• Bruising.
• Pain when the ankle is touched (tenderness).
• Inability to move the foot or bear weight on the foot.

How is this diagnosed?

This condition may be diagnosed based on your symptoms, a physical exam, and X-rays. You may also have other imaging tests, including:

• MRI.
• CT scan to look for bony fragments.
• An ultrasound to check blood flow (Doppler study). This may be done to help find out if any blood vessels were damaged.

How is this treated?

This injury is treated with a procedure to return the bones to their normal position. This needs to be done as soon as possible to prevent complications and improper healing. There are two kinds of reductions:

• Closed reduction. This kind is done without surgery. It is done after a medicine is given to make you fall asleep or to numb your ankle.
• Open reduction. This kind is done with surgery. It may be done if you also have a fracture, an open wound, or a blood vessel injury. It may also be done if a closed reduction is not successful.

After a reduction, you may have to wear a splint, boot, or cast to keep your foot and ankle still (immobilized) while healing. You may need plates and pins outside your body to hold your ankle in place as it heals (external fixator). After your ankle has healed, you will start doing exercises (physical therapy) to improve the strength and range of motion of your ankle.

Follow these instructions at home:

If you have a splint or boot:

• Wear the splint or boot as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint or boot if your toes tingle, become numb, or turn cold and blue.
• Do not let your splint or boot get wet if it is not waterproof.
• Keep the splint or boot clean.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast or splint is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Activity

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Rest your ankle as told by your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Make sure to use equipment that fits you.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• Your pain medicine is not working.
• You have a fever.
• Your foot or toes are cold, numb, or tingling.
• Your cast, boot, or splint becomes damaged.

Subtalar Dislocation, Phase I Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Ankle alphabet

1. Sit with your left / right leg supported at the lower leg.
   1. Do not rest your foot on anything.
   1. Make sure your foot has room to move freely.
2. Think of your left / right foot as a paintbrush, and move your foot to trace each letter of the alphabet in the air. Keep your hip and knee still while you trace. Make the letters as large as you can without feeling discomfort.
3. Trace every letter from A to Z.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Gastroc and soleus stretch, passive

1. Sit on the floor with your left / right leg straight.
2. Loop a belt or towel around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
3. Keep your left / right ankle and foot relaxed and keep your knee straight while you use the belt or towel to pull your foot and ankle toward you. You should feel a gentle stretch behind your calf or knee.
4. Hold this position for __________ seconds.
5. Repeat the exercise with your knee bent. You can put a small pillow or rolled towel under your knee to support it. You should feel a stretch deep in your calf.

Repeat each stretch __________ times. Complete these stretches __________ times a day.

Exercise C: Gastroc stretch, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly. Your heels should be on the floor.
3. Keeping your heels on the floor and your back knee straight, shift your weight slightly toward the wall. Do not let your back arch. You should feel a gentle stretch in your calf.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Soleus stretch, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly. Your heels should be on the floor.
3. Keeping your heels on the floor, bend your back knee and shift your weight slightly over your back leg. You should feel a gentle stretch deep in your calf.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise E: Dorsiflexion with band

1. Secure a rubber exercise band or tube to an object that will not move if you pull on it, such as a table leg.
2. Secure the other end around your left / right foot.
3. Sit on the floor, facing the object with your left / right leg extended. The band or tube should be slightly tense when your foot is relaxed.
4. Slowly pull your left / right foot toward you using your ankle and toes.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Plantar flexion with band

1. Sit on the floor with your left / right leg extended.
2. Loop a rubber exercise band or tube around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
3. Hold the two ends of the band in your hands. The band or tube should be slightly tense when your foot is relaxed.
4. Slowly point your toes downward, pushing them away from you.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Subtalar Dislocation, Phase II Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Gastroc and soleus stretch, standing

1. Stand on the edge of a step on the balls of your feet. The ball of the foot is on the walking surface, right under your toes. Hold onto the railing or a chair for balance.
2. Slowly lift your uninjured foot, allowing your body weight to press your left / right heel down over the edge of the step. You should feel a stretch in your left / right calf.
3. Hold this position for __________ seconds.

Repeat __________ times with your left / right knee straight and __________ times with your left / right knee bent. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Plantar flexion, standing

1. Stand with your feet shoulder-width apart.
2. Keep your weight evenly spread over the width of your feet while you rise up on your toes. Use a wall or table to steady yourself, but try not to use it for support.
3. If this exercise is too easy, shift your weight to your left / right leg until you feel challenged.
4. If told by your health care provider, use only your left / right side.
5. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Eversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around the ball of your left / right foot. The ball of the foot is on the walking surface, right under your toes.
3. Hold the ends of the band in your hands, or secure the band to a stable object.
4. Slowly push your foot outward, away from your other leg.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Inversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around the ball of your left / right foot. The ball of the foot is on the walking surface, right under your toes.
3. Hold the ends of the band in your hands, or secure the band to a stable object.
4. Slowly push your foot inward, toward your other leg.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Balance exercises

These exercises help improve your ankle strength, balance, and reaction.

Exercise E: Single leg stand

1. Without shoes, stand near a railing or in a doorway. You may hold onto the railing or door frame as needed for balance.
2. Stand on your left / right foot. Keep your big toe down on the floor, and try to keep your arch lifted.
3. If this is too easy, you can try doing it while closing your eyes or standing on a pillow.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Tandem walking

Do this exercise in a hallway or room that is at least 10 ft. (3 m) long.

1. Stand with one foot directly in front of the other. You can use the walls to help you balance if needed, but try not to use them for support.
2. Slowly lift your back foot and place it directly in front of your other foot.
3. Continue to walk in this heel-toe way for __________ ft. (__________ m) or for as long as told by your health care provider.

Repeat __________ times. Complete this exercise __________ times a day.