Posterior subtalar dislocation

Abstract

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.