_Treatment of Dislocation of Ankle._--The patient having been anæsthetised, the foot is extended and the knee and hip joints flexed to relax the calf muscles as completely as possible. Traction is then made upon the foot, while counter-extension is applied to the leg, and the bones are manipulated into position. Reduction usually takes place gradually without the characteristic snap which accompanies reduction of most dislocations. It is sometimes necessary to divide the tendo Achillis, particularly in cases of forward dislocation.
When the talus passes upwards between the tibia and fibula, it is sometimes impossible to effect reduction by manipulation, and the best results are then obtained by operation.
The after-treatment consists in keeping the leg on a pillow between sand-bags, and carrying out the usual massage and movement.
In compound dislocations which have become infected, primary amputation may be indicated, but in young and healthy subjects an attempt may be made to save the foot.
#Dislocation of the talus# from its articulations with the bones of the leg above and the calcaneus and navicular below, is a comparatively common injury, and results from a violent wrench of the foot. It may be incomplete or complete. When the foot is plantar flexed at the moment of injury, the displacement is generally _forward_ with a tendency outward. The talus comes to rest on the third cuneiform and cuboid bones, the foot being abducted, inverted, and displaced medially. In a large proportion of cases the dislocation is compound, more or less of the talus being forced through the skin (Fig. 100).
[Illustration: FIG. 100.--Compound Dislocation of the Talus.]
When the foot is dorsiflexed at the moment of injury the displacement is _backward_, but this is rare, as is also _dislocation to one or other side_, and _dislocation by rotation_, in which the talus is rotated in its socket. In all these injuries the body of the talus loses its normal relationship with the malleoli.
An attempt should be made to reduce the dislocation under anæsthesia, the limb being placed in the same position as for reduction of dislocation of the ankle. While traction is made upon the foot, an assistant presses directly on the displaced bone and endeavours to manipulate it into position. In incomplete dislocations this usually succeeds, but it not infrequently fails in those which are complete, and under these circumstances it may be necessary to chisel through the lateral malleolus to admit of reduction, or to excise the talus. In most cases of compound dislocation also, this bone should be removed.