Question - Ankle complications (subtalar subluxation)

by Mallory
(Canada)

Two months ago, I aggravated a previous left ankle sprain by mis-stepping. X-rays ruled out a fracture, and I was diagnosed with an anterior subtalar subluxation. I was referred to physio and their evaluation also picked up subluxing peroneal tendons. There has also been continuing tenderness above the anterior talo-fibular ligament.

Physio has been attempting to properly remobilize the fibula. However, it seems to hit a block where attempts to completely reduce the subtalar problem aggravate the tendons and mobilization of the fibula doesn't take place sufficiently because the talus remains slightly out of place. I've been taping the tendons for support and applying tape under tension to pull my calcaneus forward (putting the joint in a more normal position), both of which help with pain and mobility.

I also tend to have a minor problem with sensory integration, which I've dealt with since childhood, but which is an additional complication to treatment.

It's still about two months before I can get an MRI, and nothing can be determined before that point, but what is the normal healing pattern for an injury of this type and does it usually require surgery?

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Question - Ankle complications (subtalar subluxation)

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Nov 19, 2008
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ankle complications
by: Bart - SII

anterior movement of the talus is quite common after a significant ankle sprain. Many times it goes untreated. I have worked with patients who had suffered 2nd or 3rd degree ankle sprains previously and continued to have ankle pain months or years later. We found that posterior mobilization of the talus helped to reduce their pain, as well as improving range of motion and accessory motion of the ankle joint.

Ultimately, the success of conservative treatment will be determined by how much laxity you have in your ankle. No amount of mobilization is going to restore the normal tension of the ligaments that help stabilize the talus - which means that you may be of best benefit from surgery to restore normal ligament function and stabilize the talus.

Your treatment over the next few weeks along with the MRI should give a clear indication as to your best treatment options.

Bart

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