Article Details

Isolated medial talonavicular “swivel” dislocation is an exceptionally rare midtarsal injury. Most reported cases are reduced in theatre under spinal or general anaesthesia, and there is little practical guidance on managing these injuries in the emergency department (ED) using procedural analgesia alone. We describe a 60-year-old woman who presented with painful deformity of the right midfoot after a low-energy injury stepping off a curb. Radiographs showed an isolated medial talonavicular dislocation with preserved subtalar and calcaneocuboid alignment. Closed reduction was performed in the ED after titrated intravenous morphine to a total of 10 mg and self-administered nitrous oxide/oxygen (Entonox). With the knee flexed to 90° and the hindfoot stabilised by an assistant, the operator applied longitudinal traction through the first ray, gently accentuated the deformity, then reversed it with controlled midfoot supination while guiding the talar head using a pincer grip. A single manoeuvre achieved reduction. Post-reduction CT confirmed an anatomically congruent talonavicular joint and a minimally displaced comminuted fracture of the lateral navicular rim. The joint was clinically stable and was treated non-operatively in a below-knee cast followed by supervised rehabilitation. At 3 months, the patient had returned to full activities without restriction, with near-symmetric range of motion and no clinical evidence of midfoot instability. This case illustrates that isolated medial talonavicular swivel dislocation can be safely and definitively managed in the ED under procedural analgesia, provided that reduction mechanics are respected, stability is formally assessed and post-reduction cross-sectional imaging confirms congruity.

Keywords: Talonavicular dislocation; Medial swivel dislocation; Chopart injury; Emergency department reduction; Closed reduction; Midfoot trauma