Lateral talonavicular dislocation after low-energy trauma.

To cite: Bosman WM, Prakken FJ, Pijls BG, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-200692 DESCRIPTION A 69-year-old woman presented to the emergency department with a painful left foot after a fall from a motorised wheelchair in an attempt to avoid a collision with a cyclist. Medical history included adipositas (body mass index (BMI) 36), diabetes mellitus, polymyalgia rheumatica, angina pectoris, lumbar stenosis L3–L4, total hip prosthesis right and left and total knee prosthesis left. After the fall, she was unable to bear weight. The physical examination was suggestive of lateral dislocation of the foot (figure 1). Pulsations and sensibility appeared intact. The radiographs of the foot/ankle showed a luxation in the talonavicular joint (‘Chopart’s joint’), whereby the foot was displaced laterally (figure 2). As there was no immediate neurovascular threat, a CT scan was acquired before reposition (figure 3), on which concomitant fractures that may require operative treatment were ruled out. In the operation theatre, the patient was sedated, to relieve pain and ensure complete relaxation and positioned in supine position. The knee was flexed to diminish tension on the gastrocnemic muscle. The lateral talonavicular luxation was reduced with longitudinal traction on the foot while applying lateral pressure on the talus. Postreduction radiographs confirmed adequate closed reduction, and because the reduction remained stable during stress examinations, no operative fixation was required and a posterior splint was applied. The postreduction CT scan showed a successful reduction of the talonavicular joint, some small Figure 1 The forefoot is displaced lateral of the talus. Note the disruption of the skin where the talus head presses on the skin.