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Hindfoot Dislocations: When Are They Not Benign?

Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City.

Acute hindfoot dislocations are usually characterized by displacement of both the talocalcaneal and the talonavicular joints. Medial dislocations are more common than lateral ones. Closed reduction is usually obtained easily. When closed attempts fail, surgical exploration and removal of recognized obstacles to reduction are necessary. Associated open wounds necessitate aggressive operative management to prevent infection. Postreduction radiographs should be scrutinized for the presence of associated fractures that require fixation or surgical removal. A short-leg walking cast should be used for 3 to 6 weeks. In rare instances, the tibiotalar joint is also dislocated, which usually necessitates open reduction or, if the injury is open, extruded, and contaminated, talar excision. All hindfoot dislocations result in some stiffening of the hindfoot. Painful degenerative arthrosis sometimes develops after this injury. Factors that predispose to poor outcomes include high-energy mechanisms, the presence of open wounds and fractures, and lateral dislocations. Painful arthrosis that does not respond to conservative treatment can be treated with selective hindfoot arthrodesis.