Open subtalar dislocation is a rare injury, accounting for about 0.1% of all dislocations and, consequently, the natural history and outcome of this injury and their relevance to treatment are not well documented. A retrospective study at Westmead Hospital revealed 10 patients who presented with this injury between 1978 and 1988. We had the opportunity to review all of these patients in 1987 and again in 1989. We found a high incidence (60%) of poor results, and that the only factor that influenced the outcome was infection. It is concluded that the poor prognosis is due to the nature of the injury itself, rather than any particular factors in the subsequent management. Specifically, there was no relation to the direction of the dislocation, the presence of fractures in the foot, the time elapsed before reduction, or the period of immobilization.