Pure Talonavicular Dislocation: A Case Report

 Corresponding author: Ismail Hssain Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Pure Talonavicular Dislocation: A Case Report Ismail Hssain *, Soufiane Abdennaji, Jaafar Boutaleb, Badr Yassi, Charaf eddine El Kassimi and Mohamed Rafai CHU IBN ROCHD, Orthopedics and Traumatology Surgery at the 32 Pavilion, Casablanca, Morocco. World Journal of Advanced Research and Reviews, 2025, 28(01), 528-531 Publication history: Received on 26 August 2025; revised on 04 October 2025; accepted on 06 October 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.28.1.3437 Abstract Introduction: Talonavicular dislocation is a rare injury that usually occurs following high-energy trauma. The mechanism of injury is a force of abduction or adduction applied to the forefoot. In this article, we present a rare case of pure medial talonavicular dislocation following high-energy trauma. Presentation of case: We report a case of pure talonavicular dislocation in a 54-year-old male. He presented at the emergency department with a history of twisting injury to his left foot. Physical examination revealed an obvious deformity of his foot associated with tenderness. No neurological deficit was present. Radiograph showed pure medial talonavicular dislocation. Closed reduction was done followed by six weeks in a cast. The patient was followed up for six months and no complications were reported. Discussion: Talonavicular dislocation is commonly associated with ligamentous disruption and midfoot fractures. Most studies reported this type of dislocation in association with a fracture of the navicular, cuboid, talus, calcaneus or metatarsal bones as a result of high-energy trauma. Conclusion: Since this type of dislocation is rare, it is important to recognize it early to avoid complications such as painful equinovarus deformity. Early reduction and immobilization are the ideal treatment for this injury. Keywords: Pure talonavicular dislocation; Orthopedic management; Follow up; Closed reduction; Talonavicular dislocation. 1. Introduction Talonavicular joint (TNJ) dislocation is a rare injury of the foot and ankle. It usually occurs after major trauma and is generally associated with a fracture rather than an isolated dislocation. We report a case of pure medial swivel dislocation of the TNJ caused by a high-energy trauma and its management. There are a few studies that discuss the outcome of the closed reduction for this subtype. This case was reported in line with the SCARE criteria 2. Case presentation A 54-year-old Moroccan gentleman was brought to the emergency department in a wheelchair with a history of trauma to his left foot. He described that he twisted his foot and fell directly on it; his ankle was inverted and internally rotated while fall in her motocycle. His past medical history was unremarkable. On examination, the patient was alert, conscious and oriented. He had a normal BMI. His vital signs were stable but he complained of a painful right foot. On local examination, there was an obvious swelling over the dorsal aspect of his right foot associated with tenderness. No open wounds were seen(fig 1). The function of the ankle joint and the toes was normal. His neurovascular status was intact. Radiograph was done and it showed a medial talonavicular dislocation (Fig. 2). The closed reduction was done in the emergency department by a senior resident under conscious sedation and it was achieved through traction and laterally directed force. Post-reduction radiograph showed good alignment of the joint (Fig. 3A, B and C), and for that reason World Journal of Advanced Research and Reviews, 2025, 28(01), 528-531 529 there was no need to intervene surgically. A below-knee non-weight-bearing cast was applied. He was instructed to not bear weight on the injured limb for 6 weeks and discharged with a standard analgesia. Symptoms and signs of compartment syndrome were explained to the patient. The patient continued to be followed up in our hospital; he was seen in the outpatient clinic after three days. The cast was intact and the pain was controlled. A radiograph was done and it showed good alignment with no displacement. He was followed up in the clinic at two weeks and one month postclosed reduction and on examination at that time, the foot was normal without any signs of instability with a good alignment on radiograph. After that the cast was removed and the patient commenced physiotherapy. At six months post-closed reduction follow up, he did physiotherapy and the pain had reduced. He regained full weight bearing and returned to his daily activities, however he was not able to do strenuous exercises like running and playing football due to severe pain. On examination, the patient had normal passive and active range of motion of the left ankle compared to the other side. Radiograph showed a good alignment with no signs of arthritis or instability. Figure 1 Clinical examination revealing a deformity with varus of the right foot Figure 2 A, B and C: X-ray of right foot (AP, Oblique, and standing views) showing medial dislocation of navicular Figure 3 A, B and C: Post closed reduction x-rays showing maintained alignment of the talonavicular joint. World Journal of Advanced Research and Reviews, 2025, 28(01), 528-531 530 3. Clinical discussion Dislocation of the midtarsal joint–which is composed of the talonavicular and calcaneocuboid articulations– is a relatively rare injury of the foot and ankle due to the strong periarticular ligamentous support at this joint. The incidence of this injury is estimated at 3.6/100.000/year [2]. Isolated TNJ dislocation requires the disruption of both medial and lateral longitudinal columns of the foot, which usually occurs following high-energy trauma as reported in the literature. However, many case reports concluded that low energy trauma can also cause such an injury [3]. The rigid bony and ligamentous support surrounding the midtarsal joints are responsible for fracture associated with dislocation rather than a pure dislocation involving these joints [4]. The prevalence of concomitant injury with dislocation of the TNJ ranges from 75% to 90% [2]. A pure isolated TNJ dislocation without any associated subtalar joint dislocations or surrounding bone fractures is rare. Williams et al. explained in their report that a fracture of the medial head of the talus could occur secondary to capsular avulsion of the talus during dislocation and possible navicular impaction into the medial talar head as the navicular is displaced medially [5]. Main and Jowett classified midtarsal injuries according to the direction of deforming force and displacement into five groups (medial, longitudinal compression, lateral, plantar, and crush). A subtype pattern of injury is the swivel dislocation at the talonavicular joint [6]. Based on radiographic and CT findings, our case was classified as a medial swivel dislocation in which medially directed force dislocates the talonavicular joint, leaving the calcaneocuboid joint intact. Up to 80% of the TNJ dislocations are medial and 17% are lateral [7]. Lateral swivel dislocation is usually associated with impacted fracture of calcaneocuboid joint [8], while medial swivel dislocation is not associated with such injuries. Williams et al. reported the first case of medial swivel dislocation associated with a fracture to the body of the cuboid [5].. In one study, the authors recommended an early CT scan or proper radiographic views to evaluate for concomitant injuries associated with TNJ dislocation [9]. Richter et al. categorized the dislocations according to the treatment method as follows: closed reduction, no internal fixation; open reduction with internal fixation; optional additional external fixation; and amputation. An initial anatomical reduction was essential for good results in all groups [10]. In another series by Garofalo et al., they concluded that low-energy, medial dislocations are most amenable to closed reduction with a poorer prognosis for either open dislocations or lateral dislocations [11]. Pehlivan described a case of medial TNJ dislocation requiring open reduction as the initial closed reduction was unsuccessful. The pathological findings that prevent the closed reaction determined during surgery and it included buttonholing of the head of the talus through the extensor retinaculum and fracture of the medial aspect of the talar head [12]. Nondisplaced fractures of the tarsal navicular can be treated in a cast with protected weight-bearing as long as the fracture's displacement is minimal [13]. Open reduction and internal fixation were performed in many cases of TNJ dislocation associated with talus fracture with a good outcome [4,9]. Closed reduction was achieved in another case of a 24-year-old man with a talonavicular dislocation associated with a nondisplaced fracture of the navicular, the patient was successfully employed as a manual worker two years after injury, and clinical examination did not reveal any pain or loss of movement range [11]. Similarly, the patient, in this case, was treated with closed reduction and he was able to achieve full weight-bearing after three months. Regarding the postreduction immobilization protocol, there is a wide variety of suggestions. A splint is used until edema subsides and then replaced by a short leg cast or inflatable boot for 3 to 6 weeks. Thereafter, the patient is allowed full weight bearing ambulation [14]. 3.1. Strengths and limitations We believe that our case report will make a significant contribution to the literature because there are a few studies that discuss the outcome of the closed reduction for this subtype of dislocation and the illustration of our case will help orthopedic surgeon who encounter a similar case in the future. Nevertheless, more studies with a higher level of evidence and higher number of patients are needed to gain a better understanding and treatment protocol of TNJ dislocation. 4. Conclusion Swivel type dislocation of the foot is a rare type of injury [2]. This injury can be caused by either medially or laterally directed force. It is usually caused by a high-energy trauma. Proper diagnosis of this injury is necessary to determine the right treatment and achieve a good prognosis. The injury can be treated through early closed or open anatomical reduction. It also should be accompanied by a period of immobilization followed by rehabilitation. World Journal of Advanced Research and Reviews, 2025, 28(01), 528-531 531 Compliance with ethical standards Disclosure of conflict of interest No conflict of interest to be disclosed. Statement of ethical approval The Security Forces Hospital Program Medical Affairs Research Committee has been requested to exempt the study from ethical approval. Statement of informed consent Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. Funding • The author did not receive support from any organization for the submitted work. • No funding was received to assist with the preparation of this manuscript. • No funding was received for conducting this study. • No funds, grants, or other support was received. References [1] Agha RA, Franchi T, Sohrabi C, Mathew G, for the SCARE Group.The SCARE 2020 guideline: updating consensus Surgical Case Report (SCARE) guidelines. Int J Surg. 2020;84:226-230. [2] van Dorp KB, de Vries MR, van der Elst M, Schepers T. Chopart joint injury: a study of outcome and morbidity. J Foot Ankle Surg. 2010;49(6):541-545. doi:10.1053/j.jfas.2010.08.005. [3] Jung KJ, Lee HS, Chang HJ, et al.** Pure isolated medial talonavicular joint dislocation following low-energy trauma: a case report. J Int Med Res. 2021;49(4):3000605211004697. doi:10.1177/03000605211004697. [4] Ross PM, Mitchell DC. Dislocation of the talonavicular joint: case report. 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