Ankle Dislocation and Sprains: Foot Dislocation (also known as Ankle Dislocation), Talus Dislocation—Causes, Symptoms, and Treatment

Foot dislocation and sprain are two different types of ankle injuries that can affect ligaments, bones, and the joint capsule. In a foot dislocation, including the specific case of talus dislocation, the bones slip out of their natural position, causing a change in the alignment of the joint surfaces. This dislocation can affect either the upper ankle joint (OSG) or the lower ankle joint (USG), or both joint segments simultaneously. Such dislocations are often caused by trauma and lead to acute instability of the joint.

A sprain, on the other hand, primarily affects the ligaments. These ligaments connect the bones to one another and provide the necessary stability in the ankle joint. A sprain occurs particularly often in the OSG and results from a sudden twisting or rolling of the foot. This causes the ligaments to be severely overstretched; depending on the severity, this can range from partial tears of individual fibers to more extensive damage to the ligaments and joint capsule.

The ankle joint and the bones of the foot © bilderzwerg / Fotolia

The cause of a foot dislocation—including a talus dislocation—is usually a sudden force applied to the ankle joint that the ligaments and tendons cannot adequately absorb. As a result of this change in the position of the joint surfaces, additional damage often occurs: Ligaments, tendons, nerves, or even bones are frequently affected. A dislocation can result in torn ligaments in the ankle joint or tears in the joint capsule, which can lead to acute instability and may require surgical treatment. 

Dislocations and sprains of the ankle joint cause similar symptoms, although the symptoms of a dislocation are generally much more severe. The separation of the bones or the overstretching of the ligaments leads to severe pain.

Typical symptoms include immediate swelling and pronounced bruising, which can sometimes spread down the leg. In addition, movement of the ankle joint is severely restricted, and any weight-bearing is painful. In the case of a dislocation, the joint may appear significantly deformed, as the bones are no longer in their normal position and the affected joint appears to be literally “dislocated.”

Ankle ligaments © bilderzwerg / Fotolia

After an injury, the ankle should be cooled immediately. This measure limits swelling, which is crucial for further treatment. This is because the less swelling there is, the easier it will be to reduce the joint later—a procedure that is often performed under pain medication or even brief anesthesia.

In addition, the ankle should be immobilized with a compression bandage and the leg elevated. If the symptoms persist or worsen, a medical evaluation is necessary. A trauma surgeon or orthopedic surgeon can then determine through targeted examinations whether there is a dislocation, sprain, torn ligament, or bone fracture.

Symptoms of a sprained or dislocated foot © Leo / Fotolia

To make a diagnosis, the flexibility of the ankle joint is first assessed and the joint is palpated. Since this can be very painful immediately after the injury, the examination is often performed while the patient is receiving pain medication.

Imaging techniques such as X-rays or ultrasound (sonography) are then used. Ultrasound allows the soft tissue structures of the joint—particularly ligaments, cartilage, and the joint capsule—to be visualized. X-rays allow for a more precise assessment of the bones, such as the navicular bone. This is particularly important when a fracture or additional bone damage is suspected.

In rare cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) is required, for example, to plan surgery or when complex injuries are suspected. However, since a CT scan involves increased radiation exposure, it is used only in exceptional cases.

If a dislocation is present, the joint bones must be returned to their original position. This is usually achieved by applying traction to the bone ends and targeted pressure until the joint surfaces are correctly aligned again. A particularly complex type is the two-joint talus dislocation, in which both the upper and lower ankle joints are affected. Dislocations can also occur in the anterior and posterior parts of the joint and require especially careful realignment.

Since the procedure can be very painful, reduction is usually performed under pain medication, local anesthesia, or brief general anesthesia. The medical term for this is “repositioning,” which is almost always performed under X-ray guidance. Afterward, another X-ray is necessary to ensure that the bone ends are properly aligned and that no additional fractures have occurred.

Further treatment is similar for both dislocation and sprain: The ankle is immobilized with a splint or cast, and medications such as diclofenac (Voltaren®) are used to reduce swelling and relieve pain.

After about 8 to 10 days, the foot should be slowly mobilized with targeted exercises to maintain the joint’s range of motion—particularly in plantar flexion and dorsiflexion. Both after a sprain with severe ligament overstretching and after a dislocation, a longer period of rest is required. It can take several months for the ligaments to fully regenerate and for the stability of the ankle joint to be restored.

Long-term joint function depends crucially on the anatomical coordination of the calcaneus and talus bones, which form the basis for stability in the upper and lower ankle joints. Surgical treatment may be advisable, particularly for young, athletically active individuals, to tighten the capsular and ligamentous structures and prevent future dislocations or sprains. Without adequate treatment, there is a risk of permanent instability or premature ankle osteoarthritis. Surgery is also unavoidable if ligaments are completely torn or if blood vessels and nerves are injured.

The prognosis for an ankle dislocation or sprain is generally good; however, permanent limitations in mobility, recurring symptoms, or sensitivity to weather changes may occur. It is particularly problematic if the stability of the ankle joint is not fully restored. A seemingly harmless twist of the ankle can lead to a long-term problem if not treated properly—which is why dislocations and sprains must always be managed by an experienced orthopedic surgeon.

Since many injuries occur during sports, athletes are often affected by a temporary or even permanent reduction in their performance. The prognosis also depends on the exact joint position—for example, whether the talus is affected between the navicular bone or below the talus. In such cases, there is a higher risk of chronic symptoms or subsequent ankle osteoarthritis.

Prevention is therefore particularly important: braces, supportive footwear, and a thorough warm-up routine can help prevent injuries. With age, the risk increases further due to the natural wear and tear of ligaments and tendons, as well as muscle atrophy.

1. What is the difference between a foot dislocation and a foot sprain?
A foot dislocation is a dislocation in which the articular surfaces of the upper or lower ankle joint—including, for example, the talus (ankle bone)—slip out of position. A sprain, on the other hand, is an injury in which the ligaments are primarily overstretched or partially torn.

2. How does a talus or foot dislocation occur?
It is usually caused by a sudden, jerky force during sports or an accident. In addition to the joint surfaces, ligaments, joint capsules, tendons, and even nerves can be affected.

3. What are the symptoms?
Typical symptoms include severe pain, rapid swelling of the ankle joint, and bruising. In the case of a dislocation, the joint may also appear visibly deformed.

4. How is it treated?
The dislocation is usually reduced (repositioned) under anesthesia, after which the joint is immobilized with a splint or cast. For a sprain, conservative treatment involving cooling, compression, and physical therapy is often sufficient. In severe cases, surgery may be necessary.