A dislocated ankle is a severe orthopedic injury where the talus bone is completely forced out of its normal alignment with the tibia and fibula. This traumatic event tears or severely stretches the ligaments that stabilize the joint. Because of the high forces involved, a dislocated ankle frequently occurs alongside fractures of the surrounding bones, which is known as a fracture-dislocation. This injury is considered a medical emergency because the misalignment can compromise the blood supply and nerve function to the foot. Prompt professional medical intervention is required to realign the joint and prevent long-term complications.
Immediate Steps Before Professional Help
Call for emergency medical services immediately following a suspected ankle dislocation. While waiting for help to arrive, the primary goal is to manage the injury. You must not attempt to move the ankle or force the joint back into place, as this action carries a high risk of catastrophic damage to the surrounding soft tissues, blood vessels, and nerves.
The injured limb should be immobilized exactly as it lies using a makeshift splint made from firm materials like rolled-up magazines or padded boards. This step prevents movement and helps maintain the current alignment. Circulation checks are important; gently feel for a pulse in the foot or check the color and temperature of the toes, noting any pallor or numbness, which should be reported to the emergency responders.
A cold compress or ice pack can be applied to the area to help mitigate swelling and pain, but it should be insulated with a cloth to protect the skin. If possible without moving the injured joint, elevate the ankle above the level of the heart. The person should not be allowed to put any weight on the injured foot, and they should be kept still and comfortable until medical professionals take over.
Professional Joint Realignment Procedures
The definitive treatment for a dislocated ankle begins in a medical setting with a procedure called reduction. Before this procedure, pain medication and often procedural sedation or anesthesia are administered. Imaging, typically X-rays, is usually performed to confirm the diagnosis, determine the direction of the displacement, and check for associated fractures.
If the dislocation is straightforward and does not involve complex fractures or open wounds, a Closed Reduction is attempted. This non-surgical technique involves the physician manually maneuvering the bones back into alignment using gentle traction and specific directional pressures.
Following a closed reduction, another set of X-rays is immediately taken to confirm the joint is perfectly realigned and to ensure no previously hidden fractures have been missed. However, if the joint cannot be successfully realigned through manual manipulation, if there are multiple or complex fractures, or if the injury is an Open Dislocation where the bone pierces the skin, an Open Reduction is necessary. Open reduction involves surgery to directly visualize the joint, clear any trapped soft tissue, and precisely realign the bones.
Stabilization and Immobilization Methods
Once the ankle joint has been successfully reduced, the next step is stabilization to allow the damaged ligaments and any associated fractures to heal. Immediately after reduction, the ankle is typically placed in a temporary splint to hold the reduction and manage initial swelling. This temporary immobilization protects the joint from re-dislocation and is maintained until definitive treatment is planned.
For dislocations without complex fractures, or after a stable closed reduction, long-term immobilization may involve a non-removable cast for a period of several weeks. The cast keeps the ankle in a fixed, neutral position, preventing movement that would disrupt the healing of the torn ligaments. Depending on the injury’s stability, a rigid walking boot or brace may be used later in the healing process or for less severe cases.
If the dislocation is accompanied by unstable fractures, or if the ligaments are too severely damaged to hold the joint in place, surgical stabilization is required. This procedure, often called Open Reduction and Internal Fixation (ORIF), involves implanting metal hardware like plates, screws, or wires to firmly hold the fractured bone segments and the joint in the correct anatomical position. Surgical stabilization ensures the joint’s integrity during the healing phase.
Long-Term Recovery and Rehabilitation
The immobilization period is only the first phase of a complete recovery. Once the cast or splint is removed, the focus shifts to restoring function, which is achieved primarily through a structured physical therapy program. The early stages of rehabilitation concentrate on regaining lost joint flexibility and range of motion.
Therapy then progresses to targeted strengthening exercises for the muscles surrounding the ankle, foot, and lower leg to build support and stability for the newly healed joint. Proprioception and balance training are also included, which retrains the body’s awareness of the ankle’s position in space to prevent future injuries. Weight-bearing activities are gradually introduced, moving from non-weight-bearing with crutches to partial and then full weight-bearing under the guidance of a therapist.
Complete recovery can take anywhere from three to six months or longer, especially if surgery was required to stabilize the joint. Adherence to the rehabilitation plan is important because inadequate recovery can result in chronic instability, recurring dislocations, or the premature development of post-traumatic arthritis in the ankle joint.