Ankle Dislocation

What is ankle dislocation?

A joint dislocation is when there is an abnormal separation between the bones of a joint. When this happens in your ankle joint, it’s called an ankle dislocation. It's a severe injury.

There are 3 bones that make up the ankle joint:

• Shinbone (tibia)

• The smaller bone in your leg (fibula)

• A bone in your foot (talus)

The ankle joint helps your foot move up and down. Below this is another ankle joint called the subtalar joint. This joint is between the talus and another bone in your foot (calcaneus). This joint lets your foot move side to side. Normally, a set of very strong ligaments hold all of these bones tightly in place.

Severe injury can pull or tear these ligaments out of place. This creates an abnormal space between 1 or more of the bones. The ligaments are very strong and don't pull away or tear easily. Ankle dislocations often occur along with a break in 1 or more of the ankle bones. In some cases, an ankle dislocation can happen without a break in the ankle bones. In these cases, the ankle dislocation occurs along with a severe ankle sprain. A severe sprain is when the ligaments are torn.

In most cases, the injury pushes the talus bone behind the other ankle bones. It may also be pushed to either side, to the front, or upwards.

Ankle dislocations can happen to people of all ages. They occur with ankle fractures much more often than with just sprains.

What causes ankle dislocation?

Ankle dislocation results from severe injury to the ankle. This tears 1 or more of the ankle ligaments. Without these ligaments to hold your bones in place, your ankle bones separate. This can happen in a motor vehicle accident. It may also happen while playing sports, especially ones that include jumping. It's more likely to happen when you have your foot pointed down during impact.

Who is at risk for ankle dislocation?

You may be at a greater risk for ankle dislocation if:

• You do a lot of athletic activities

• You’ve had an ankle sprain, fracture, or dislocation in the past

• Your ankle has been abnormal since birth

• You have a condition that makes your ligaments loose, such as Ehlers-Danlos syndrome

• You smoke cigarettes or are obese

What are the symptoms of ankle dislocation?

With your ankle injury, you may have symptoms such as:

• Immediate, severe pain

• Swelling and bruising

• Soreness to the touch

• Inability to put weight on your foot

• Trouble moving your ankle

• A deformed look to your ankle

• A bone that pokes through your skin

How is ankle dislocation diagnosed?

Your healthcare provider will talk with you about your symptoms and about your health history. They will give you a physical exam and check you for other injuries. The healthcare provider may put pressure on parts of your lower leg and ankle. This is to check for pain and swelling. Your provider may also check that blood vessels in your leg aren’t stopping blood flow to your foot and ankle.

You will need X-rays of your leg, ankle, and foot to look for broken bones. You may also need a CT scan or an MRI. These let your provider look at your injury with more detail.

How is ankle dislocation treated?

You will likely see an orthopedic doctor to treat your injury. Your treatment may vary depending on the type of your dislocation and any other injuries. Your treatment may include: 

• Pain medicines

• A doctor moving your bones back into place without surgery (closed reduction)

• Keeping your ankle raised (elevated) and using cold packs

• In some cases, emergency surgery

• A splint to hold your ankle in place at first

• A cast or boot to hold your ankle once your swelling goes down

You might need surgery to treat your injury. During your surgery, your doctor will put your bones back in place to let them heal correctly. This is called reduction. Your doctor may use special plates and screws to keep the bones in place. This is called internal fixation. They may also fix tears to your ligaments.

After your leg has healed a bit, your doctor may give you a removable brace or splint. This is so you can start physical therapy. These exercises will help you restore and keep your range of motion and strength. You will likely need to use crutches or a cane for a few months after your injury. Your doctor or physical therapist will let you know when you can go back to normal activities.

Your doctor might also prescribe you a medicine to prevent blood clots in your leg while you recover. This is called a blood thinner. You might also need antibiotics if your injury caused a break in your skin.

Your doctor may give you advice about your diet. A diet that is rich in calcium, vitamin D, and protein can help you heal. Your doctor may ask you to not use certain over-the-counter medicines for pain. Some of these may delay normal bone healing. If you smoke, your doctor will advise you to stop smoking. Smoking can also delay bone healing.

What are possible complications of ankle dislocation?

You might have complications from your ankle dislocation, such as:

• Stiffness in your joint (physical therapy may help)

• Ankle arthritis causing lasting (chronic) ankle pain

• Infection, which may need treatment with antibiotics or follow-up surgery

• A broken bone that fails to heal correctly, which might need follow-up surgery

• Pain from the plates and screws used in your surgery (these may be removed at a later date)

• Problems with wound healing

• Blood vessel or nerve damage from your dislocation or fracture

• Blood clot

Your risk of complications may vary according to your general health and how severe your injury is. Follow all of your doctor’s instructions carefully. This will help to reduce your risk of complications.

When should I call my healthcare provider?

Call your healthcare provider right away if your pain is getting worse instead of better. Let your provider know if you have any numbness or swelling in your leg, or a high fever or chills. Call 911 if you have any sudden, severe symptoms, such as sudden shortness of breath.

Key points about ankle dislocation

• An ankle dislocation is a severe injury in which there is an abnormal separation between one or more of the bones of your ankle joint.

• With your injury, you might have severe pain right away, swelling, and a deformed look to the ankle. You likely won't be able to put weight on your foot.

• Your healthcare provider can diagnose your condition with a physical exam and X-rays.

• Treatment may include splints, casts, moving your bones back in place, and pain medicines.

• Many people will also need surgery.

• Some people may have complications. These can include an infection or arthritis in the ankle.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.