Ankle > 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.

In general, 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 occurs.

Your physician 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.

Ankle dislocations 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:

   Immediately call for an ambulance.

   Do not attempt to move the injured ankle or the injured person unless someone is present who knows how to properly immobilize the ankle.

   Dislocations 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.

   If 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.

Paramedics 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.