Medical Imaging Analysis Report

I. Radiological Findings

Based on the provided foot X-ray and CT images, the following major features can be observed:

• The left foot axis is markedly deviated, suggesting disarray of the tarsal bones.
• From the X-ray and CT images, an increased or abnormally displaced space between the talus and calcaneus is observed, indicating a subtalar joint dislocation.
• The overall positioning of the remaining tarsometatarsal joints appears acceptable, and no obvious fracture line is detected. However, due to high-energy trauma, small avulsion fractures or articular surface injuries should be carefully ruled out.
• No definitive signs of soft tissue tearing are visible on imaging, but the abnormal joint alignment is clearly evident.

Overall imaging characteristics are consistent with a subtalar dislocation. The CT 3D reconstruction further supports this abnormality, showing a significant disruption of the normal anatomical relationship between the talus and surrounding bony structures.

II. Potential Diagnoses

Taking into account the high-energy trauma (a fall from approximately 2 meters) and the clinical manifestations of foot pain, swelling, and deformity, the imaging findings support the following possible diagnoses:

1. Subtalar Dislocation
   Primary rationale:
   • Abnormal alignment of the talus and calcaneus on imaging, consistent with a typical presentation of subtalar dislocation.
   • This injury commonly results from high-energy trauma; the patient’s mechanism of injury (fall or twisting force) is a frequent cause of such dislocations.
   • Often associated with significant swelling and functional limitation, aligning with the clinical presentation.
2. Possible Concurrent Fracture
   Rationale:
   • Although no prominent fracture line is detected in the images, small avulsion fractures or bone fragment separation should be excluded. Strong ligamentous traction can cause microfractures.
3. Partial Injuries or Dislocations of the Midtarsal (Chopart) Joint
   Rationale:
   • Subtalar dislocation may be accompanied by mild subluxation of the tarsometatarsal or talonavicular joint, which warrants clinical differentiation.

In summary, the primary concern remains “subtalar dislocation,” requiring integration of clinical examination and additional (e.g., stress X-ray, further CT reconstruction) assessments for comprehensive evaluation.

III. Final Diagnosis

Considering the patient’s mechanism of injury (fall from height resulting in foot impact), clinical presentation (pain, deformity, restricted movement), and X-ray/CT findings, the most likely diagnosis is:

Left subtalar joint dislocation (possibly medial subtalar dislocation).

No definite large fracture fragments are identified at this time, but the possibility of small avulsion fractures cannot be ruled out. Confirmation should be carried out via intraoperative inspection or follow-up imaging studies.

IV. Treatment Plan and Rehabilitation

Based on the diagnosis of “subtalar dislocation,” treatment and rehabilitation should comprehensively consider the extent of joint damage, ligamentous tears, and soft tissue status.

1. Treatment Strategy

1. Urgent Manual Reduction:
   • Perform “traction-reposition” under general anesthesia or adequate analgesia, often referred to as the “boot-pulling” method, aiming to restore normal foot anatomy as soon as possible.
   • If closed reduction fails or there is significant displacement of fracture fragments, consider open reduction and internal fixation (ORIF).
2. Post-reduction/Postsurgical Immobilization:
   • After successful reduction, immobilization (e.g., short leg cast or brace) is typically required for 4–6 weeks, adjusted according to ligament and fracture healing status.
3. Medication Management:
   • In the early phase, analgesics and anti-inflammatory drugs (NSAIDs) may be employed for pain and swelling control, and prophylactic anticoagulants (e.g., low molecular weight heparin) may be used to prevent deep vein thrombosis as needed.

2. Rehabilitation / Exercise Prescription Recommendations

Rehabilitation should be carried out progressively under the guidance of physicians and rehabilitation therapists, adhering to the FITT-VP (Frequency, Intensity, Time, Type, Volume, Progression) principles to ensure both safety and efficacy.

1. Early Phase (Immobilization and Protection, approximately 0–4 or 6 weeks):
   • Immobilization and protection: use a brace or cast to limit joint movement and avoid weight-bearing on the foot.
   • Permitted activities:
     • Isometric exercises for other lower limb muscle groups, such as the quadriceps and hamstrings.
     • Gentle movements of adjacent joints (e.g., toe flexion and extension, ankle pump exercises), if they do not compromise the immobilized area.
   • Goal: maintain strength in the rest of the lower limb, reduce swelling, and promote circulation.
2. Intermediate Phase (Functional Recovery, approximately 4–8 weeks):
   • After partial or complete release from immobilization by medical advice, begin gradual partial weight-bearing exercises (e.g., walking with the support of crutches).
   • Perform active and passive range of motion exercises of the ankle joint, progressively increasing the movement range.
   • Engage in proprioceptive training to enhance joint stability, starting with seated or light weight-bearing conditions.
   • Intensity and frequency: about 15–20 minutes per session, 1–2 times daily, with mild discomfort but tolerable effort.
3. Late Phase (Comprehensive Strengthening, approximately 8–12 weeks or longer):
   • Once bone and ligament healing is sufficiently stable, transition to single-crutch or non-crutch ambulation, gradually returning to full weight-bearing.
   • Incorporate strength training, such as heel raises, toe walking, balance board exercises, to strengthen the triceps surae and peri-ankle muscles.
   • Aquatic walking or slow-paced exercises may be introduced to diminish stress on the joints via buoyancy.
   • Emphasize proprioceptive and dynamic balance training to prepare for resuming daily activities and sports.
4. Maintenance Phase & Activity Progression:
   • When range of motion and muscle strength are largely restored, gradually return to low-impact activities (such as cycling and swimming).
   • If returning to running or other high-impact sports, ensure absence of significant swelling or pain, and that sufficient lower limb strength and balance have been achieved. Progress under the guidance of a professional therapist or coach.

V. Disclaimer

This report is based on the submitted clinical information and imaging data and is intended solely for reference, not as a substitute for in-person consultation or the advice of professional physicians. The definitive diagnosis and treatment plan should be determined by the relevant specialist in conjunction with the patient’s specific condition, surgical findings, and clinical examinations.