Any forceful injury or impact to the ankle joint results in the adjoining bones to lose contact with each other resulting in ankle dislocation. Ankle dislocations frequently occur with a sprain, fracture of the ankle or total rupture of the lateral ligaments. The dislocation can be superior, posterior or anterior.
Ankle dislocation is rare and when it occurs, it is almost associated with a fracture. The ankle is very strong and complex, hence the ankle joint rarely gets dislocated. The cause of the dislocation can be an indirect trauma causing the ankle to flex abnormally. The dislocation can occur in any direction and is very painful. All ligaments on one side get torn resulting in the ankle joint dislocation. This commonly occurs on the external region of the ankle, where three ligaments are present. These ligaments are often injured during an ankle sprain.
Symptoms of a Dislocated Ankle or Ankle Dislocation
- Abrupt severe pain.
- Inability to use the ankle.
- The ankle appears crooked or deformed as the tibia and fibula lose contact with each other.
- Tenderness is present.
- Swelling is present.
- In case of nerve damage, numbness and tingling in the foot is present.
- If the blood supply is diminished, then foot can feel cold or turns a blue/white color.
Causes of a Dislocated Ankle or Ankle Dislocation
Athletes involved in contact sports and especially those athletes who don't wear ankle supports are at high risk for this injury. Examples are baseball players, cross-country runners as they run on uneven and rough surfaces, athletes with old ankle injuries etc. Individuals suffering from arthritis and having poor muscle tone are also at risk for dislocating their ankles.
Treatment of a Dislocated Ankle or Ankle Dislocation
Conservative Treatment For Ankle Dislocation
Dislocated ankle or ankle dislocation is a serious injury if associated with fracture of tibia or talus bone. Patient is often unable to walk for several weeks and abnormal healing can result in deformed ankle as well as prolonged pain. Treatment choice depends on partial ankle dislocation, complete ankle dislocation and dislocation associated with fracture of anklebone.
- Cold Therapy- Partial or complete ankle dislocation is extremely painful. Intensity of pain is often exaggerated with extensive subcutaneous bleeding. Subcutaneous bleeding is restricted during immediate phase following injury by applying cold pack or direct ice. The treatment is continued for 72 hours. Ice packed is left over ankle joint on and often for 5 to 10 minutes for 1 to 2 hours every 4 hours. Cold therapy helps with pain as well as prevents bleeding and ankle joint swelling. The recovery time for dislocated ankle or ankle dislocation is faster with less hematoma and joint swelling.
- Heat Therapy- Heat therapy includes heating pad or direct application of infra red light. Heat therapy helps to relieve pain. Heat therapy is advised for chronic pain and pain lasting for long time. Heat therapy often helps to improve circulation. Heat therapy is avoided for first 2 to 3 weeks following injury of ankle resulting in dislocation.
Treating Dislocated Ankle With Closed Reduction
Ankle subluxation or partial dislocation is successfully treated with closed reduction. Complete reduction of ankle is successfully reduced to normal anatomical position in thin patient. It is often difficult to reduce complete dislocated ankle fracture in obese patient. Closed reduction is often attempted with success in patients who may have a hairline or stable fracture of tibial, fibula or talus bone. The closed reduction often fails when partial or compete fracture is associated with unstable fracture or comminuted fracture of anklebones. Closed reduction is performed under general anesthesia. Closed reduction when performed under sedation may fail if muscles are partially relaxed or not relaxed at all. Procedure is attempted under general anesthesia in surgery room. Failed closed reduction is often followed by open reduction.
- Braces and Cast For Dislocated Ankle- Immediately following closed reduction, ankle joint is placed in braces or cast. Brace or cast is left for 4 to 6 weeks. Ankle is examined after 2 and 4 weeks to evaluate position of joint. Any complications or recurrence of ankle dislocation is treated with open reduction and surgery.
Medications For Dislocated Ankle or Ankle Dislocation-
- NSAIDs- Joint capsules and ligaments are inflamed following injury. The inflammation is treated with anti-inflammatory medications. Most common anti-inflammatory medications used are motrin and naproxen which are known to cause side effects of stomach pain and ulcer. Complaints of stomach pain and ulcer are often treated with Celebrex. NSAIDs are contraindicated if patient has history of stomach ulcer or bleeding. NSAIDs are used in few cases after wound and fracture is healed to reduce the tissue inflammation.
- Opioids- Opioid is used for chronic pain during initial phase immediately following injury. Opioid treatment is essential for first 2 to 3 weeks. Pain intensity reduces after first 2 to 3 weeks and pain is controlled with NSAIDs. Pain caused by partial dislocation is treated with hydrocodone, while pain caused by complete dislocation with or without fracture of anklebone is treated with oxycodone or morphine. Severe pain is frequently treated with intravenous opioids such as morphine or fentanyl. Fentanyl injection is short acting opioid. Morphine is intermediate acting opioid. Therapeutic effects of morphine last for 3 to 4 hours when given intravenously and 4 to 6 hours when given orally as pills. Long acting opioids used to control pain are fentanyl patch, Oxycontin pills and methadone pills. The dose and frequency of treatment depends on intensity of pain, tolerance of opioids and side effects.
- Muscle Relaxants- Dislocated ankle or ankle dislocation is in few cases associated with muscle spasm of calf and foot muscles. The continuous muscle spasm adds to the acute pain caused by ankle dislocation. Muscle spasm is treated with muscle relaxants. Most common muscle relaxants used are flexeril, baclofen and skelaxin. Muscle spasm is observed as tight painful muscle contraction over bottom of the foot and calf of lower leg. Muscle relaxants helps to releive pain caused by muscle spasm and improves muscle contractility.
- Anti-anxiety Medications- Patient is anxious following injury resulting in dislocated ankle or ankle dislocation. Anxiety decreases pain threshold and causes increased intensity of pain. Anti-anxiety medication in anxious patient helps to increase pain threshold.
- Treatment of Neuropathic Pain- If the pain is continuous for 3 to 6 months then it becomes chronic and neuropathic. Neuropathic pain does not respond to opioids and NSAIDs. The best treatment option is to try anti-neuropathic pain medications such as antidepressants Cymbalta or Seville and antiepileptic Neurontin.
Physical Therapy For Dislocated Ankle or Ankle Dislocation
- Patient is advised physical therapy after the dislocation is healed by conservative treatment or surgery. The calf and foot muscles are often atrophied following prolonged immobilization of foot and leg during treatment. Physical therapy helps to rebuild the muscles of the leg and also improves joint movement. The ankle joint become stiff following surgical treatment and prolonged immobilization of joint by using cast or braces.
Surgery For Dislocated Ankle or Ankle Dislocation
- Surgery is performed under general anesthesia.
- Partial Dislocation- The partial dislocation is reduced under anesthesia. Anatomical position of the joint is maintained by using plate either on medial or lateral side. The plate is anchored to bones of the ankle joint by multiple screws. The plates and screw prevents revision of partial dislocation.
- Complete Dislocation- The complete dislocated ankle is treated by using two plates. Plates are placed on medial (inner) and lateral (outer) side. The plates are anchored to the anklebone by inserting multiple screws through the bones. Plate and screws are removed once the dislocation is healed.
- Complete or Partial Ankle Dislocation with Fracture of Ankle Bones- If dislocation of ankle joint is associated with fracture then internal fixation of fracture and reduction of dislocation is performed at the same time. The fracture fragments are fused together by plates and screw or wires. The ankle dislocation is treated with plates and screws.
Post Surgery Rehabilitation For Dislocated Ankle or Ankle Dislocation
- Patient is often advised post-surgical rehabilitation, which includes physical and occupational therapy. Physical therapy is used for muscle strengthening and improves joint movements. Occupational therapy is advised to readjust the function of the lower leg. Continuous pain or restricted ankle joint movements may interfere with certain profession and job. Patient may need to change job or adjust the ankle movements.
Dislocated Ankle or Ankle Dislocation: Prognosis and Recovery
Patient may suffer with prolonged pain following complete healing of the ankle joint dislocation. The radiological image may suggest normal alignment of the joint, while patient is complaining of pain while using the ankle joint. Prognosis is excellent when partial dislocation is treated with closed reduction than open reduction. Surgical reduction of the ankle joint dislocation often results in stiff ankle joint after prolonged joint immobilization. Stiff ankle joint often results in pain. Recovery period to complete healing of the dislocated ankle or ankle dislocation is about 6 to 8 weeks. The recovery period is longer if joint dislocation is associated with fracture of tibia or talus bone. The recovery period is often 8 to 12 weeks when complete ankle dislocation is associated with anklebone fracture. Patent may resume normal activities after 12 to 16 weeks.