Foot Dislocation Treatment

Foot dislocation involves inter-phalangeal, metatarso-phalangeal, tarsal-metatarsal and Inter-tarsal foot joint. Traumatic dislocation may be associated with fracture of foot bone. Foot dislocation treatment depends on type and complications associated with dislocation. Most of the inter-phalangeal dislocation is reduced with close reduction under sedation. Foot dislocation when associated with the fracture, the treatment recommended is open reduction and instrumentation. The open surgery with placement of K-wire, screw or plate is advised to stabilize joint and fracture segment.

Foot Dislocation Treatment

Emergency Room Admission Following Foot Dislocation

  • Patient is brought to the ER either by relatives or ambulance from the place of accident and injury following foot dislocation.
  • Patient is often in severe foot pain when he/she arrives at emergency room.
  • Foot Dislocation may be associated with other injuries and fracture.
  • Blood loss following foot dislocation with or without fracture of foot bone may cause anemia and tachycardia.
  • Patient will be admitted to ER for further treatment.

Acute Foot Dislocation Pain-

  • Pain less than 3 months in duration is considered as acute pain. Acute ankle and foot pain following foot dislocation is extremely severe in intensity.

Treatment Of Foot Dislocation In Emergency Room (ER)

Medications For Foot Dislocation Pain-

  • Pain Medication Prescribed Following Foot Dislocation
    • Non-Steroidal Anti-Inflammatory Drugs- NSAIDs
      • Effective in treating mild to moderate pain.
      • NSAIDs are preferred analgesics to treat acute pain if patient has a history of opioid addiction or dependence.
      • NSAIDs are avoided in patients with history of foot dislocation if patient has a history of stomach pain or ulcer.
      • Most common side effects following NSAIDs treatment is stomach pain, stomach ulcer and bleeding ulcer.
      • Most common used NSAIDs are Motrin, Naproxen and Celebrex.
    • Opioid Therapy For Pain Following Foot Dislocation
      • Preferred and effective analgesics to treat severe to very severe pain.
      • Avoided in patient suffering with foot dislocation with history of opioid addiction
      • Common Side effects are nausea, vomiting and constipation
      • More serious side effects are opioid dependence, addiction and sleep apnea.
      • Most common used opioids are hydrocodone, oxycodone, morphine and methadone
  • Close Reduction: Treatment For Foot Dislocation
    • Treatment For Foot Dislocation Without Fracture
      • Close reduction is performed under sedation or general anesthesia.
      • Close reduction is followed by placement of the selective cast depending on the location of the dislocated joint.
      • The cast helps to immobilize the joint and prevent recurrence of the foot dislocation.
      • Follow up X-Rays are performed to evaluate the position of the dislocated foot joint.
      • Following foot joint dislocations are treated with close reduction-
        • Inter-phalangeal foot joint dislocation
        • Metatarsal-phalangeal foot joint dislocation
        • Metatarsal-tarsal foot joint dislocation
    • Treatment For Foot Dislocation With Fracture
      • Inter-phalangeal joint dislocation is less difficult to treat with close reduction when associated with fracture of phalangeal bone.
      • Inter-phalangeal foot joint dislocation associated with fracture of phalanges is often treated with close reduction. The recurrence of dislocation and separation of two fracture segments of the bone is prevented by cast.
      • Metatarsal-phalangeal joint dislocation associated with fracture of phalanges or metatarsal bone is also treated with close reduction and casting.
      • Reduction of foot dislocation is difficult to treat if dislocation is associated with fracture of metatarsal or tarsal bone.
      • Subtalar foot dislocation with fracture is rare and treated with closed or open reduction.A

Elective Treatment For Foot Dislocation

Medications

  • Analgesics (Pain Medication) For Foot Dislocation Pain
    • NSAIDs- Mild to moderate pain following foot dislocation is treated with non-inflammatory pain medications. Treatment is continued for 3 to 4 weeks. NSAIDs are discontinued if patient is complaining of abdominal pain or any signs of peptic ulcer. Most common NSAIDs prescribed are Motrin, Naproxen and Celebrex.
    • Opioids- Opioids are prescribed for severe foot pain. Foot pain following surgical treatment may last for 2 to 3 weeks. Short acting opioids are preferred during first 3 weeks of treatment. If requirement of opioids exceeds after 3 weeks then long acting opioid is prescribed with short acting opioid for breakthrough pain. Opioid prescribed for foot pain following foot dislocation are as follows-
      • Long Acting Opioids- Oxycontin, MSContin and Duragesic Patch
      • Short Acting Opioids- Oxycodone (Percocet), Hydrocodone (Vicodin, Norco and Lortab) and MS IR (Immediate Release Morphine Sulphate)
  • Antibiotics For Wound Infection Associated With Foot Dislocation
    • Antibiotics are prescribed if foot dislocation with or without fracture is associated with open skin wound over the dislocated joint.
    • Antibiotics are also prescribed if there is a sign of fever or wound infection observed.
  • Anti-Inflammatory Medications For Joint Or Soft Tissue Inflammation
    • Patient is treated with NSAIDs alone if there is sign of tendonitis or sprained ligament caused by dislocation. Severe pain associated with joint, tendon or ligament inflammation is treated with opioid and NSAIDs.

Surgical Treatment For Foot Dislocation

  • Closed Reduction of Foot Dislocation and Associated Fracture
    • Initially, closed reduction is attempted following initial admission at ER.
    • Recurrent dislocation is initially treated with elective closed reduction.
    • Elective closed reduction of foot dislocation is performed in surgical center.
  • Open Reduction of Foot Dislocation and Fracture
    • Indication For Open Reduction-
      • Unstable dislocation
      • Failed close reduction
      • Multiple recurrence of dislocation after closed reduction
      • Irreducible foot joint dislocation. D
      • Closed reduction fails because of soft tissue such as ligament, capsule, or tendon that may interpose in the joint. In such situation incision and direct visual observation helps to isolate and remove the soft tissue interposing the joint.D
    • Open Reduction and Instrumentation C
      • K-Wire Internal Fixation Of Foot Dislcation
        • Unstable dislocated foot joint is stabilized by K-Wire. K wire is inserted and placed inside shaft of proximal and distal bone. Ends of K-Wire are tightened to maintain normal anatomical position of dislocated foot joint.
        • K-Wire internal fixation is used to treat all types of foot dislocation associated with or without fracture.
        • K-wire fixation of foot dislocation is preferred treatment in tarso-metatarsal and metatarsophalangeal dislocation.B
      • Internal Fixation of Foot Dislocation Using Screws-
        • Foot dislocation is reduced under x-ray and direct vision.
        • Screw is passed from proximal bone of the dislocated joint in to distal bone.
        • Screws of different diameter are available and selection of size of the screw is important to prevent fracture of the shaft.
        • Screw is placed in the shaft of proximal and distal dislocated bone.
        • Screw is useful to hold fractured fragment if foot dislocation is associated with fracture.
        • Screw holds fractured fragments and dislocated bones together better than K-Wire.
        • Inter-phalangeal, metatarsal-phalangeal, inter-tarsal and tarsal-metatarsal dislocation is treated with screw and internal fixation.
      • Screws and Plate
        • Most of the foot dislocation is treated with K-Wire or metal screws.
        • Screws and plate placement is a preferred treatment for inter-tarsal dislocation associated with fracture of one of the tarsal bone.
        • Plates are available in different size, shape and thickness.
        • Selection of size, shape and thickness of the plate is important to prevent skin and subcutaneous tissue destruction.

Post-Surgical Treatment For Foot Dislocation

  • Pain is recognized as chronic pain if it lasts beyond 6 months.
  • Pain may continue following surgery until fracture and soft tissue wound is healed.
  • Chronic pain is treated with long and short acting opioids. Long acting opioids are prescribed twice or three times a day. Short acting opioids are prescribed for breakthrough pain.
  • Muscle Relaxants
    • Muscle relaxants are prescribed for muscle spasm and muscle pain.
    • Most common muscle relaxants prescribed are Baclofen, Skelaxin and Flexeril.
  • Massage Therapy
    • Long-term cast causes muscle weakness and muscle atrophy in lower leg and foot.
    • Massage therapy is prescribed following removal of the cast.
    • Massage therapy is performed twice or three times a week for 6 to 8 week.
  • Physical Therapy (PT)
    • Physical therapy is useful to improve foot joint movement and function of the leg muscles.
    • Prolonged cast causes foot joint stiffness.
    • Joint stiffness is treated with supervised physical therapy.
    • Physical therapy includes supervised movement of the foot joints and leg muscle contractions.
    • Physical therapy for foot dislocation is prescribed for over 6 weeks.
  • Interventional Therapy
    • Interventional therapy is rarely used in foot joint dislocation.
    • Chronic foot joint pain following removal of cast is treated with local anesthesia and cortisone injection. Temporary pain relief helps to continue with aggressive physical therapy of the joint.
    • Post healing joint tendonitis and sprain is treated with frequent cortisone injection with local anesthesia.
    • Initial therapy includes three injection in 6 to 8 weeks then repeat injections every 3 to 4 months.

Also Read:

References:

A. Lateral subtalar dislocation associated with bimalleolar fracture: case report and literature review.

Conesa X1, Barro V, Barastegui D, Batalla L, Tomás J, Molero V.

J Foot Ankle Surg. 2011 Sep-Oct;50(5):612-5.

B. Reverse floating first metatarsal and floating third metatarsal with Lisfranc fracture dislocation: an unusual injury.

Singh AP1, Singh AP, Chadha M.

Acta Orthop Traumatol Turc. 2010;44(2):169-71.

C. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation.

Rammelt S1, Schneiders W, Schikore H, Holch M, Heineck J, Zwipp H.

J Bone Joint Surg Br. 2008 Nov;90(11):1499-506.

D. Irreducible dislocation of the hallucal interphalangeal joint.

Leung HB1, Wong WC.

Hong Kong Med J. 2002 Aug;8(4):295-9.

E. Interphalangeal dislocation of toes: a retrospective case series and review of the literature.

Yang IB1, Sun KK, Sha WL, Yu KS, Chow YY.

J Foot Ankle Surg. 2011 Sep-Oct;50(5):580-4.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 30, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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