Subtalar dislocation of the hindfoot is a rare injury and can be associated with poor functional outcomes. We report a case of an irreducible subtalar dislocation in an elite athlete, who returned to elite sport.

A 28 year old competitor in the world mountain bike championships was injured in a high speed fall from his mountain bike during a competitive downhill run in July 2007. He had an obvious deformity at the scene and a fracture dislocation of the ankle was suspected. The injury was closed and neuro-vascular status was intact. Radiographs revealed the ankle mortise was intact with the talus anatomical, but a subtalar dislocation was present which proved irreducible in the emergency department.

The patient was taken to the operating theatre and the dislocation was reduced through a short antero-medial arthrotomy using a blunt lever and traction. Post- reduction, the joint was stable and was supported in a below knee cast. He was kept partial weight bearing for 6 weeks and then had an intensive physiotherapy rehabilitation regime. Serial radiology showed no evidence of avascular necrosis or other skeletal abnormalities.

Our patient has since returned to elite Mountain Biking and won the British National Championships in 2008 and the World Championships in Canberra in 2009.

Introduction

Surgical treatment options for osteoarthritis of the first MTPJ include fusion, excision arthroplasty, interposition arthroplasty and replacement arthroplasty. ¹ Arthroplasty of the first MTPJ is not a treatment modality that is, as yet, widely accepted. ^2,3 although early results are promising.

The Toefit-plus (tm) first MTP joint arthroplasty is an uncemented modular hemi or total joint replacement. The aim of this study was to look at the short to medium term outcome of the Toefit-plus(tm) system, performed by a single surgeon in a district general hospital.