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| IMAGE QUIZ |
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| Year : 2014 | Volume
: 2
| Issue : 2 | Page : 128-129 |
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An unusual cause of ankle pain
Engin Senel1, Huseyin Gunturkun2, Seher D Senel3
1 Department of Dermatology, Hitit University Faculty of Medicine, Çorum, Turkey
2 Birecik First Family Health Center, Urfa, Turkey
3 Ministry of National Education, Çorum, Turkey
| Date of Web Publication | 18-Jul-2014 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-631X.137016
How to cite this article:
Senel E, Gunturkun H, Senel SD. An unusual cause of ankle pain. Saudi J Med Med Sci 2014;2:128-9 |
A 29-year-old man presented with a 2-week history of severe pain of his left ankle. He reported no difficulty in the activities of daily living and complained of a slight pain in his left foot during playing basketball or on prolonged standing. He had no recent trauma history. Physical examination did not reveal erythema, edema, varicose veins, and tenderness. His foot showed marked swelling and was pronated and slightly internally rotated [Figure 1]. He had pain on plantar flexion, extension and pronation of the left ankle. No pain was reported on internal or external rotation.
| Question | |  |
What is the diagnosis?
| Answer | | |
Radiography disclosed unilateral isolated navicular dislocation without fracture [Figure 2]a and b] and minimal deformation of the cuneiform bones. The patient stated that he had a traffic accident at the age of 5. The patient had been hit by a motorcycle on his left foot. | Figure 2: Radiography of the left foot and ankle showing an isolated navicular dislocation. (a) Anteroposterior radiograph of left foot. (b) Oblique radiograph of left foot
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| Discussion | | |
Isolated dislocations of the tarsal bones are extremely rare since strong ligament support the plantar and dorsal sides of the navicular bone. [1],[2] Only six cases of isolated navicular dislocations without fracture are reported in the literature. [1],[2],[3],[4],[5],[6] The pathogenesis of this condition is not clear. [1] This traumatic dislocation involves disruption of both the dorsal and plantar ligaments and capsular structures attached to the navicular. [4] The patient was consulted to the Clinic of Orthopedics and Traumatology. Local intra-articular injection of triamcinolone acetonide was administrated to relieve the pain. Arthrodesis was planned if the patient's condition needed as a further process.
Treatment options of the isolated navicular dislocation and their outcomes are controversial. [1] Closed reduction is not a referable treatment option and recent reports recommended primary arthrodesis, Kirschner wires, and external fixation. [6]
| References | | |
| 1. | Gosselin RA, Silverstein RM, Gomez RA. Isolated bilateral tarsal navicular fracture-dislocation. Orthopedics 1992;15:201-5. 
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| 2. | Vaishya R, Patrick JH. Isolated dorsal fracture-dislocation of the tarsal navicular. Injury 1991;22:47-8.
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| 3. | Dixon JH. Isolated dislocation of the tarsal navicular. Injury 1979;10:251.
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| 4. | Freund KG. Isolated dislocation of the tarsal navicular. Injury 1989;20:117-8.
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| 5. | Pathria MN, Rosenstein A, Bjorkengren AG, Gershuni D, Resnick D. Isolated dislocation of the tarsal navicular: A case report. Foot Ankle 1988;9:146-9.
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| 6. | Yoshino N, Noguchi M, Yamamura S, Takai S, Hirasawa Y. Bilateral isolated tarsal navicular fracture dislocation: A case report. J Orthop Trauma 2001;15:77-80.
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[Figure 1], [Figure 2]
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