> Ankle Dislocation
What is an Ankle Dislocation ?
An ankle dislocation occurs when your anklebone (talus)
is knocked out of its normal position under your lower
leg bones (tibia and fibula) by an unusually strong
or violent force. Depending on which direction the bones
move, the surrounding bones, ligaments, tendons, or
cartilage may be damaged. Ankle dislocations are very
often associated with fractures. Two main sets of ligaments
attach the talus to the tibia and fibula. The deltoid
ligament attaches the tibia to the talus on the inside
of your ankle. On the outside of your ankle, the talofibular
ligaments attach the fibula to the talus. A strong force
can disrupt your ankle ligaments. This can dislocate
your talus, or pop it into a position where it does
not rest between and below the tibia and the fibula.
An ankle dislocation is an emergency medical situation
that can potentially damage any or all of the structures
in your ankle. The blood supply or nerve connections
to your ankle also may be damaged, and the skin and
soft tissue around your ankle may be torn or cut by
fractured bone. Therefore, if you suspect an ankle dislocation,
you should go to a hospital’s emergency room as
soon as possible.
A strong or
violent force, such as that resulting from a car accident
or other high-velocity impact, is usually required to
dislocate your ankle. A direct blow during sports or
other physicial activities is an uncommon causes for
dislocations, but they do occur. Football, hockey and
soccer are the some of the sports in which athletes
frequently suffer ankle disclocations. Significant twisting
injuries or hard falls, called axial loading, are the
most common causes of ankle dislocations in sports.
An ankle dislocation commonly is caused by an unexpected
change in how your foot strikes the ground. When you
step on someone’s foot or on an uneven piece of
ground, your foot can tilt. Before you have time to
react, your ankle can severely twist out of position.
In an instant, the entire weight of your body and the
force of your motion can cause your foot to roll to
the outside. As this is happening, the leg actually
pivots around to the inside. These opposing rotational
forces may cause the bones and ligaments to break or
tear. To fracture or dislocate an ankle, the forces
must be dramatic. Poor muscle strength is another contributing
cause of ankle dislocations. The peroneal muscles, which
run along the outside of the lower leg and cross the
ankle, are responsible for bringing the foot up and
out to the side. Athletes who lack proper peroneal muscle
strength may have trouble keeping their feet and legs
in an appropriate position when an unexpected twist
occurs. There is no evidence that if you have had a
prior ankle sprain you are at a higher risk for dislocation,
since dislocations are rare.
After the ambulance
drops you off in the hospital's emergency room, you
will probably be moved onto a new gurney. You are usually
taken to a room where someone on the health care staff,
either a nurse or doctor, should recognize the dislocation
and take you immediately to a physician. Most patients
do not receive treatment of their ankle fractures by
ER physicians. Instead, the ER physician may order X-rays
to check for any fractures or bone chips, and you probably
will be taken for X-rays as the ER physician calls an
orthopedic surgeon to evaluate your ankle. Most people
are given narcotic painkillers as soon as they have
been properly moved to an area where a physician can
begin making a diagnosis.
the ER physician or orthopedic surgeon makes a thorough
physical exam while deciding the best way to put the
joint back in place, a process known as reduction. To
test the integrity of the ligaments and tendons in your
ankle, your physician will touch or gently push the
joint to see if your foot moves too easily in any direction.
Your ankle is then put back into place as soon as possible
after the diagnosis is made. It is important to do this
- a procedure called reduction - before too much swelling
helps calm you down and gives you painkillers. You will
probably remain awake but given narcotic painkillers
as your ankle is put back in place. You may also be
given muscle relaxants. A dislocated ankle usually is
very unstable. Your foot is gently pulled outward, but
the joint does not pop back into place as a shoulder
might. Your physician, with the aid of nurses, positions
your foot in the ankle joint and holds it in place while
a cast is applied. Your ankle will not stay in place
by itself, and must stay in a splint or cast until surgery
is performed. More X-rays of your ankle usually are
taken to make sure the bones are properly set in the
cast. The link to the left explains in detail standard
open surgical repair of an ankle dislocation.
require immediate treatment. Physicians suggest an ambulance
be called to transport someone with a dislocated ankle
to a hospital’s emergency room. If you or someone
you know dislocates an ankle, the following first aid
tips can help you better understand what to do:
call for an ambulance.
not attempt to move the injured ankle or the injured
person unless someone is present who knows how to properly
immobilize the ankle.
may cause open wounds that should be covered with sterile
dressings, like gauze, to prevent infection. Physicians
recommend covering an open wound with a clean blanket
or towel if no sterile dressings are available and letting
the paramedics proceed from there.
possible, do not let injured people eat or drink, since
they may be going under anesthesia soon. The paramedics
can administer fluids intravenously if necessary.
will most likely immobilize your ankle and place you
securely onto a gurney in the back of the ambulance.
It is a good idea to have someone accompany you to the
hospital to help you. The ride may be bumpy with frequent
stops and starts, so try to stay calm. Most dislocated
ankles cause substantial pain, but paramedics generally
do not treat you before arrival at the ER. Try to be
patient in the ambulance. Remember that a dislocated
ankle can cause a variety of damage to ankle tissues,
which requires a proper diagnosis in the emergency room
before ankle dislocations can be reset.