The prompt identification of peri-talar dislocation with immediate reduction and early range of motion will generally result in a good outcome. Higher energy injury with greater soft tissue compromise and associated fractures worsen the prognosis. Salvage procedure for post-traumatic degenerative changes require arthrodesis for relief of pain. The deformity is usually apparent on physical examination, but occasionally is masked by marked early swelling. A high index of suspicion should be maintained with high or low energy injury to the foot and ankle with normal ankle radiographs. This particular case is unusual in that the patient was able to function as a farmer even with the fracture dislocation. This again is probably explained by his mild peripheral neuropathy. This case, however, does demonstrate the difficulty in making the diagnosis.

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