Foot Dislocation (Foot Bones Popped Out)

What is Foot Dislocation (Foot Bones Popped Out)?

Dislocations of the foot are rather rare and can happen in several joints within the foot. This article focuses on the three joints most often affected by such injuries. Dislocations can occur on their own, or go hand-in-hand with bone fractures. The three joints most frequently dislocated are the subtalar joint, midtarsal joint (also known as Chopart joint), and the tarsometatarsal or TMT joint complex, often referred to as the “Lisfranc Joint.” It is crucial to recognize these injuries because they can often be overlooked, particularly Lisfranc injuries, when first examined. If not properly treated, these injuries can cause osteoarthritis and long-term disability.

What Causes Foot Dislocation (Foot Bones Popped Out)?

Just like with other movable joints in your body, certain activity patterns tend to lead to specific foot dislocations. These dislocations could happen due to direct or indirect injury. Common ways this can happen include falls from high places, car accidents, or sports-related injuries. Lisfranc injuries, a type of foot injury, often occur from these activities due to twisting forces and the weight pushing down on a bent foot.

Subtalar dislocations, another kind of foot dislocation, usually happen after intense incidents like falling from great heights or high-speed car crashes with the foot turned inward or outward. Midtarsal dislocations tend to occur from similarly intense incidents when force is applied to a foot that has been bent downwards.

Risk Factors and Frequency for Foot Dislocation (Foot Bones Popped Out)

Dislocations in the subtalar region, involving the talus and calcaneus bones of the foot, are the most common type of foot dislocations. However, these types of injuries are still rare, making up only 1% of all dislocations. They are most often found in young to middle-aged men. The midtarsal region is the second most common location for a combination of fracture and dislocation in the midfoot area, usually right after injuries to the Lisfranc joint. Lisfranc injuries, which involve fracture-dislocation, are the least common type of foot dislocations and make up only 0.2% of all fractures. Males in their thirties are more likely to experience these injuries.

• Subtalar dislocations, affecting the talus and calcaneus bones in the foot, are the most common type but still very rare, making up about 1% of all dislocations. These mostly occur in young or middle-aged men.
• Midtarsal dislocations, which hit the midfoot, are the second most common fracture-dislocation, usually following injuries in the Lisfranc joint.
• Lisfranc injuries, involving fracture-dislocation, are moderately common among foot dislocations. They account for about 0.2% of all fractures. These injuries are usually seen in men in their thirties.

Signs and Symptoms of Foot Dislocation (Foot Bones Popped Out)

When a patient comes in with a foot injury, it’s crucial to understand the history and how the injury occurred. This information can provide a hint towards what kind of injury might have taken place. Many times, if a person can’t put weight on the foot after hurting it, this might indicate a dislocation or fracture.

During a physical check-up, evidence of bruises or visible deformities are often the first things a medical professional will look for. Lisfranc injuries, a specific type of foot injury, can be identified by swelling in the middle of the foot, a foot that is stuck in a downward position (plantar flexion), and bruising on the underside of the foot. People with Lisfranc injuries often feel pain in the middle of the foot especially when putting weight on it, like when going downstairs.

A medical professional will then carry out some tests for a Lisfranc injury:

• The piano key test: This involves moving the toe bones up and down and observing any resulting pain or bones that may be slipping out of place.
• Compression of the midfoot: This test looks for any pain or clicks that might be produced by pressure on this area.
• Stability test: This is where the back part of the foot is held while the front part is twisted and moved to one side, checking for any discomfort this might cause.

Visually, subtalar dislocation (a type of joint dislocation in the foot) is usually evident. The foot can either be locked in an inwards (supination) or outwards (pronation) position, depending on whether the dislocation is medial or lateral, respectively. Lisfranc dislocations present with the foot stuck in a plantarflexion position.

After these general observations, the medical professional will feel the foot for swelling and pain, indicating the specific area that’s injured. It’s also important to check the blood vessels and nerves for any damage. This is done by evaluating the pulses at the top (dorsalis pedis) and back (posterior tibial) of the foot. The speed at which blood returns to the skin after pressure is applied and released (capillary refill) should also be assessed before and after any necessary corrective procedures.

Testing for Foot Dislocation (Foot Bones Popped Out)

Different imaging techniques can be used to identify and diagnose joint dislocations. Traditional X-rays, for instance, can pinpoint broad separation at the joint linking the bones in the midfoot and toes, known as the tarsometatarsal joint. Computed tomography (CT) scans are more sensitive and can uncover smaller displacements and specific injuries in the foot’s Lisfranc joint. Ultrasounds can also measure the length and thickness of the Lisfranc ligament on the foot’s upper side.

However, magnetic resonance imaging (MRI) is the best technique for identifying issues with ligaments. High-intensity injuries can normally be seen using these imaging methods when the patient is not putting weight on the foot. But, if the first X-rays are unclear for low-intensity injuries, additional X-rays may be needed with the patient’s weight on the foot. This is particularly important when looking for possible Lisfranc injuries.

Dislocations in the subtalar joint, which is under the ankle, are often evident through a visible change in foot shape. Standard X-rays showing the talus bone moving into the space between two leg bones can confirm this diagnosis.

For midfoot dislocations, the starting point should be X-rays from different angles of the foot and ankle. If X-rays don’t provide enough information, CT scans could be necessary to spot tiny fractures or to help prepare for surgery. Since bone injuries are usually more critical in these cases, MRI is often not used in the first evaluation.

Treatment Options for Foot Dislocation (Foot Bones Popped Out)

Foot injuries require accurate diagnosis for effective treatment. It’s essential to understand the type of dislocation that has occurred, as this will inform the treatment plan. Quick repositioning or “reduction” of the dislocation is important to lower the risk of tissue death due to a lack of blood supply. Mild sprains that don’t involve a displaced joint can be treated by immobilizing the foot and avoiding putting weight on it, while ligament injuries may need a form of joint fusion.

If the foot injury involves a subtalar fracture or dislocation (an injury in the back part of the foot), a number of different internal fixation surgeries and joint fusion methods are available. The goal is to reduce pain and improve the foot’s structure and function. Immediate reduction is performed under sedation if possible, but sometimes tissue blockages or stuck dislocations require open surgery.

A Lisfranc injury involves damage to the midfoot area and can lead to severe complications if not treated promptly. In most cases, immediate surgical intervention is needed. The best treatment often involves an open reduction and internal fixation surgery combined with joint fusion. Although relatively few in number, some successful cases have used a less invasive treatment called a Lapidus plate system. Percutaneous fixation, another less invasive surgical option, has shown to be an effective alternative for some types of Lisfranc injuries.

In many cases of midtarsal dislocation (displacement of the middle region of the foot), an initial try for closed reduction is recommended, but most of these injuries end up needing an open reduction and surgical fixation. In severe cases, a temporary external fix might be used before final internal fixation, once other health issues have been addressed.

If surgery is performed, it’s necessary to reassess the affected foot. This includes physical examinations and repeat imaging tests to see how well the surgery worked. To control initial pain, doctors usually give medications such as morphine, fentanyl, and ketorolac through an IV. After initial treatment, patients might take oral medications like NSAIDs, acetaminophen, or oral opioids. The goal should be to limit opioid use when possible.

Foot dislocation, regardless of the type, often means patients should avoid putting weight on the affected foot whether they have surgery or not. After surgery, non-weight bearing can last for six to eight weeks. Afterward, the patient may need to use a walking boot or cast based on the kind of injury and the patient’s progress with rehabilitation.

What else can Foot Dislocation (Foot Bones Popped Out) be?

When a patient first comes to a doctor with foot pain that wasn’t caused by an injury, the doctor will consider several possibilities, including:

• Stress fracture (a tiny break in the bone)
• Injury to the soft tissues (like muscles or tendons)
• Injury to the ligaments (the connective tissue that holds bones together)
• Plantar fasciitis (inflammation of the band of tissue that connects the heel bone to the toes)
• Morton’s neuroma (a painful condition that affects the ball of your foot)
• Tarsal tunnel syndrome (a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve)
• Nerve entrapment (a trapped nerve)

When a patient first comes to a doctor with foot pain caused by an injury, the doctor will consider several possibilities including:

• Dislocation of the subtalar or peritalar joints
• Dislocation of the midtarsal (referred to as Chopart’s) joint
• Dislocation of the Lisfranc – tarsometatarsal joint
• Dislocation of the talar bone (one of the bones in the ankle)
• Fractures in the hindfoot (the back part of the foot)
• Fractures in the midfoot (the middle part of the foot)
• Fractures in the forefoot (the front part of the foot)
• Injuries to the ligaments in the hindfoot, midfoot, or forefoot

In either case, the doctor will determine the correct diagnosis through careful examination and appropriate tests.

Possible Complications When Diagnosed with Foot Dislocation (Foot Bones Popped Out)

While acute complications from foot dislocations are uncommon, they can still occur. One such complication might be compartment syndrome, which is a serious condition related to increased pressure within muscle compartments. If this is suspected, it should be confirmed using a device called a hand-held manometer. Very rarely, untreated Lisfranc injuries (dislocations or fractures that occur in the middle of the foot) can even result in the need for amputation.

Unfortunately, long-term complications are much more common following foot dislocations. Many patients report stiffness after these injuries and often show signs of wear and tear on follow-up X-ray images. Like fractures, dislocations, and sprains in other parts of the body, foot dislocations can speed up the onset of osteoarthritis, which is a type of joint disease that causes breakdown of joint cartilage and underlying bone.

Preventing Foot Dislocation (Foot Bones Popped Out)

It’s important to inform patients about the complexity of foot dislocations and the potential long-term effects, such as osteoarthritis. This education is crucial to encourage patients to attend all follow-up appointments, adhere to their rehabilitation program, and correctly follow all post-surgery instructions. Understanding these instructions can go a long way in ensuring a successful recovery.