The ankle consists of three bones that are attached by muscles, tendons, and ligaments that connect the foot to the leg. The lower leg is two bones called the tibia (shin bone) and the fibula. These bones articulate (connect) to the ankle bone at the tibiotalar joint (ankle joint) allowing the foot to move up and down. Overall, the foot and ankle in the human body work together to provide balance, stability, movement, and propulsion.
Most commonly, an ankle dislocation is associated with fractures of the distal ends of the tibia and fibula (also called malleolus) in association with damage to the ligaments that help support the ankle joint. Generally, a dislocation occurs when the bones no longer hold their normal anatomical relationship. A dislocation interrupts the relationship between the talus and tibia in the ankle.
Medical professionals describe the dislocation from the perspective of the talus to the tibia. The most common ankle dislocation is a posterior dislocation (in which the talus moves posteriorly in relationship to the tibia); this occurs when a force drives the foot backward. As with all other ankle dislocations, the likelihood of an associated fracture is high.
Besides a posterior dislocation, an ankle dislocation can also occur to the anterior, lateral, and superior. A significant amount of force causes all ankle dislocations, making it likely that there are also other injuries present. Fractures of the tibia and fibula are common, as well as ligamentous disruptions.
Causes & Symptoms of an Ankle Dislocation
The most common type of ankle dislocation is the posterior dislocation, where the talus moves backward in relation to the tibia. For this to happen, the foot will need to be plantar-flexed (the toes are pointing downward) when the injury occurs.
The ankle is either forced inwards from the outside or outward from the inside, tearing the ligaments and the tissues that hold the ankle stable. Below are other dislocations that may occur in the ankle:
Superior dislocations of the ankle
This is when the talus is jammed upward, into the space between the tibia and fibula, as a result of an axial loading injury and is known as a pilon injury. This may be due to landing on one’s feet from a fall or from being in a car accident where the foot is held firmly against the brake pedal.
Lateral dislocations of the ankle
Lateral dislocations occur when the ankle is twisted, either inverted or everted. However, there are always fractures associated with either the medial or lateral malleolus or even both.
Anterior ankle dislocations
This is where the talus is pushed forward and the foot is fixed or dorsiflexed (where the toes are pointed upward). The force from in front of the foot pushes the tibia backward.
Usually, ankle dislocations occur from forces placed on the ankle that cause the bones to fracture or the ligaments to tear, resulting in the dislocation injury. Some common causes of dislocations include falls, motor vehicle accidents, and sports injuries.
Throughout symptoms of an ankle dislocation, there is usually obvious deformity of the ankle joint. It may be difficult or almost impossible to stand or walk. If the nerves that run across the ankle joint are damaged or inflamed, there can be numbness and tingling of the foot. There is also almost immediate swelling of the ankle joint area and bruising may occur rapidly. Depending on the condition of the injury, there can be other injuries of the foot, knee, or spine.
Ankle pain can also be associated with other symptoms such as:
- Burning sensation
Who gets an Ankle Dislocation?
Commonly, children and adolescents have the most ankle dislocations, and they occur more frequently in males, which is related to the higher incidence of traumatic injuries found in males than females.
Injuries related to motor vehicle accidents, falls, and sports injuries are the common causes of ankle dislocations. In addition, patients who have medical conditions causing joint hypermobility (such as Ehlers-Danlos syndrome) are at an increased risk for dislocations. A history of multiple ankle sprains and weakness of the muscles around the ankle increases the risk of a dislocation.
Other risk factors include the following:
- Increase in activity level – Suddenly boosting the frequency or duration of activity sessions can increase your risk of ankle dislocation.
- Smoking – Cigarette smoking can increase your risk of developing osteoporosis. Some studies have shown that healing after a fracture may take longer in people who smoke.
- Other conditions – For example, having a decreased bone density can put you at a higher risk of injuries to your ankle bones.
- Improper equipment – Faulty equipment, such as shoes that are too worn, can contribute to stress fractures and falls.
- Participation in high-impact sports – Direct blows and twisting injuries that occur in sports such as basketball, football, tennis, and soccer can cause dislocated ankles.
How Does an Ankle Dislocation Affect You? How Serious are they?
There are several complications that can present themselves after a dislocated ankle has been left untreated. Certain complications include arthritis, osteomyelitis, compartment syndrome, and nerve or blood vessel damage, as described below:
- Osteomyelitis – If you have an open fracture, meaning one end of the bone protrudes through the skin, your bone can be exposed to bacteria that can cause infection.
- Arthritis – Ankle fractures that extend into the joint can cause arthritis years later. If your ankle begins to hurt longer after a break, it is recommended to seek medical attention for evaluation.
- Compartment syndrome – This condition can occur with ankle dislocations – it causes pain, swelling, and sometimes disability in the affected muscles of the legs.
- Nerve / blood vessel damage – Trauma to the ankle can severely injure nerves and blood vessels, sometimes tearing them. Lack of blood flow can cause a bone to die and collapse.
Recommended Treatment & Rehabilitation for an Ankle Dislocation
During a diagnosis for an ankle dislocation, your doctor will begin by examining your ankle to check for points of tenderness. The accurate location can help determine its cause of the injury. Your doctor may also move your foot into different positions to check your range of motion.
If your signs and symptoms suggest a break or fracture, your doctor will then recommend one or more of the following imaging tests below:
- Bone scan – A bone scan can help your doctor diagnose fractures that do not show up on X-rays. A technician will inject a small amount of radioactive material into a vein. This material is then attracted to your bones, especially the parts of your bones that have been damaged.
- X-rays – Most ankle fractures can be visualized on X-rays. The technician may need to take X-rays from different angles so that the bone images will not overlap.
- MRI and CT scans – Depending upon the situation, CT and MRI scans might be considered to evaluate the damage to the joint surface, to look for hidden fractures, and to assess the ligaments and tendons that surround and stabilize the ankle joint.
Treatments for an ankle dislocation vary depending on the severity of the condition:
- Medications – Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen to help reduce inflammation and swelling due to the dislocation.
- Crutches – Crutches can help you walk around without bearing weight on the injured ankle.
- Reduction – If your dislocated ankle has moved out of place, your doctor might need to physically move it back into position. This non-surgical treatment is also known as closed reduction.
- Cast, splint, or walking boot – Mild ankle dislocations can be treated with a cast, splint, or walking boot. These treatments keep the bone in place as it heals.
A physiotherapist can help treat a dislocated ankle after it has been treated by a physician. After the bone is healed, a physiotherapist can help you regain your strength, motion, balance, and sport skills. After your leg is placed in a cast or a cast boot, your physiotherapist will teach you how to walk without bearing weight on the injured ankle, using crutches or a walker. Some of these physiotherapy treatments will include:
- Reducing swelling – Swelling is commonly the first signs after an ankle dislocation. Treatment may include gentle massage, the use of a compression wrap, ice, or heat, and elevating the affected ankle when at rest.
- Walking instruction – Your physiotherapist will help you begin to put some of your weight on the injured leg, gradually progressing to full weight.
- Gait training – Your physiotherapist will offer specific instruction and exercises to restore a normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps.
- Restoring your ankle mobility – Your physiotherapist may use manual therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness, and increase the ankle’s bending range of motion.
- Returning to your regular activities – As you regain strength and flexibility, your physiotherapist will provide further training specific to your daily activities.
Your physiotherapist will design an exercise plan for you to begin after the cast has been removed to help you strengthen and regain motion in your dislocated ankle. The following exercises include:
Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Next, place a towel around your affected foot just under the toes. Hold one end of the towel in each hand, with your hands above your knees. Pull back gently with the towel so that your foot stretches toward you. Hold the position for 15-30 seconds, then repeat 2-4 times a day.
Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Keeping your affected leg straight, gently flex your foot back toward your body so your toes point upward. Then slowly relax your foot to the starting position. Repeat this method 8-12 times a day.
Resisted ankle inversion
Sit on the floor with your good leg crossed over your other leg. Hold both ends of an exercise band and loop the band around the inside of your affected foot. Then press your good foot against the band. Keeping your legs crossed, slowly push your affected foot against the band so that the foot moves away from your good foot. Slowly relax, then repeat 8-12 times a day.
Resisted ankle eversion
Sit on the floor with your legs straight. Then, hold both ends of an exercise band and loop the band around the outside of your affected foot. Next, press your good foot against the band. Keeping your leg straight, slowly push your affected foot outward against the band and away from your good foot without lifting your leg. Repeat this exercise 8-12 times a day.
Alternative & Homeopathic Treatment for an Ankle Dislocation
Several alternative treatments include the use of Epsom salt or simply resting your injured ankle. Some homeopathic treatments include:
- Rest – It is recommended to not carry heavy items or play sports for a few days or weeks after you have dislocated your ankle in order to reduce further pain.
- Eat healthy – Nutrients and vitamin D contained in meals can both help support your ankle recovery. You can also take vitamin D supplements as well.
- Epsom salt – You can soak your ankle in a warm bath with Epsom salt after a few days of injury. Epsom salt may help soothe sore muscles and connective tissues, and it may help with joint stiffness.
- Ice application – Apply ice to the ankle several times a day to help reduce pain and swelling.
- Compression – Apply an elastic compression bandage to help limit swelling.