HISTORY: A 27 year-old minor league baseball player presents to the ER with right ankle pain after sustaining an injury landing on first base. After hitting a ground ball, the player ran to first base and inverted his right ankle after stepping on the first baseman’s foot. He had immediate pain and an obvious deformity in the right ankle. He was not able to ambulate due to pain. He was neurovascularly intact. There was no obvious skin puncture. The patient’s right foot and ankle were immobilized on the field in a SAM splint, and the player was sent to the ER. He denied any previous injury to this ankle.
PHYSICAL EXAM: Examination of the right foot and ankle revealed an obvious deformity of right ankle without laceration or skin puncture. Patient was able to move all toes but unable to move the ankle due to pain. He was neurovascularly intact. Exam was limited due to pain.
1. Subtalar Dislocation
2. Talonavicular Dislocation
3. Talus Fracture
4. Tibia Fracture
TEST AND RESULTS:
Right ankle and foot x-rays: Closed dislocation of the medial subtalar joint and talonavicular joint without obvious fracture.
Right Medial Subtalar dislocation, Talonavicular Dislocation, Talus Fracture
DISCUSSION: Consent was obtained, and the patient was taken to the OR for reduction under general anesthesia. After reduction of the right ankle, CT was performed which showed a successful reduction of the medial subtalar and talonavicular dislocations. The CT also revealed a nondisplaced fracture of the medial border of the talus. He was placed in a posterior splint and stirrup and made non-weightbearing. It was not determined why this relatively low impact mechanism caused such rare and significant injuries. Proper reduction was critical in this case to avoid future equinovarus deformity, ankylosis, or severe degenerative arthritis warranting further intervention.
OUTCOME: The patient was unable to play baseball for the remainder of the season. However, due to his successful reduction, he did not require further interventional treatment. He was transitioned to a short leg walking boot after being non-weightbearing for 6 weeks and participated in a physical therapy program to regain strength and function of his right ankle. His roster status was changed from “disabled” to “active” 8 weeks after his injury.