A Rare Case of a Medial Peritalar Dislocation on a Rock Climber

Peritalar dislocations are rare and account for only 1% of all traumatic foot injuries. The talonavicular and the subtalar joints are dislocated; the tibiotalar and calcaneocuboid joints remain intact. Associated injuries are not uncommon. Sports related peritalar dislocations have been reported. However, there are no cases reported on rock climbers.

We report the case of a healthy 38-year-old patient, seen after a climbing accident against the wall. He presented a severe varus deformity of the hindfoot and an ankle hematoma and the talar head was palpable laterally against the skin. The radiological assessment showed a medial peritalar dislocation of the left foot. The dislocation was successfully closed reduced in the emergency room under sedation using axial traction and external translation maneuver. Non-operative treatment with cast immobilization and non-weight-bearing was performed for 6 weeks. At 6 months, the patient walked physiologically, without limping. He returned climbing and the subtalar joint did not show any stiffness.

An understanding of the mechanism of injury is necessary to attempt a closed reduction which should be performed as quickly as possible to avoid skin necrosis. An open reduction might be necessary. After reduction, a complete radiological assessment is necessary to exclude associated fractures. The direction of the dislocation, the energy of the accident, the timing of the reduction, as well as the joint's stability after reduction have a direct impact on the clinical and functional outcomes.