Ankle Pain

Understanding Talar Fractures

talus fractureThe talus is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). Where the talus meets the bones of the foot, it forms the subtalar joint, which plays an important role in walking and stabilization. The talus is an important connector between the foot and the leg and body, helping to transfer weight and pressure forces across the ankle joint. The talus has no muscular attachments and is mostly covered with cartilage, which makes injuries difficult to heal.

What causes a talus fracture?

Talus fractures are often the result of high-energy injuries. Most injuries to the talus result from motor vehicle accidents, although falls from heights also can injure the talus. These fractures also may occur from twisting the ankle, particularly when significant weight bearing forces are involved, which can result in small chips or fragments that are broken off the edges of the talus. Talus fractures may occur in running and jumping sports involving change of direction such as soccer, football, basketball, etc.

Signs and symptoms of a talus fracture

Many patients with a talus fracture will experience a sudden onset of intense pain and swelling about the ankle following the injury. The pain will usually be felt at the front of the ankle—although it may be felt on the sides or back of the ankle—and may lead to an inability to walk due to bruising and swelling, often to protect the talus. In severe cases, particularly involving a displaced fracture of the talus, the patient will be unable to bear any weight on the area. One common sign of a talus fracture is pain that increases during certain movements of the foot or ankle or when standing or walking up hills or uneven surfaces.

How are talus fractures diagnosed?

In many cases the diagnosis can be made by your physician on physical examination alone. He or she will examine your foot, and an X-ray is usually required to confirm diagnosis and assess the severity of the injury.

Treatment for a talus fracture

Depending on the severity of the injury, a talus fracture may be treated with either a cast or possibly surgery. Your orthopedic specialist will advise the patient which management is most appropriate based on a number of factors, including the location, severity and type of the fracture. It’s important to note that a talar fracture that is left untreated or that doesn’t heal properly will most likely create problems for you later. Your foot function will be impaired, you may develop arthritis and chronic pain, and the bone may collapse.

Non-surgical treatment

In rare cases, a talus fracture can be treated without surgery if X-rays show that the bones have not moved out of alignment. You will have to wear a cast for at least six to eight weeks and will not be able to put any weight on the foot during that time.

Surgical treatment

Most fractures of the talus require surgery to minimize later complications. Your orthopaedic surgeon will realign the bones and use metal screws to hold the pieces in place. If there are small fragments of bone, they may be removed and bone grafts may be used to restore the integrity of the joint.

Recovery

Recovery can be prolonged, with no weight or walking on the leg being allowed for eight to 12 weeks.
Patients with a fractured talus should perform flexibility, strengthening and balance exercises as part of their rehabilitation to ensure proper healing. This aspect of rehab is important, as balance, soft tissue flexibility and strength can be quickly lost with inactivity. Most people, depending on the type and severity of the fracture, are able to return to most work and recreational activities.

About Dr. William Reisman

William Reisman, MDWilliam Reisman, MD, specializes in Orthopedic Trauma and has been practicing at Emory since 2010. He is the Chief of Orthopedics at Grady Memorial hospital and is the Director of Orthopedic Trauma. His interests include general fracture care, pelvic and acetabular fractures, periarticular fractures and multi-extremity injuries. He has active research focusing on areas of fracture care, acute compartment syndrome and cost savings analysis at Level I trauma centers.

Related Resources

Takeaways from Dr. Olufade’s Ankle Sprain Chat

Ankle SprainThanks to everyone who joined us Tuesday, May 27, for our live online chat on “Symptoms, diagnosis and treating an ankle sprain,” hosted by Emory Orthopaedics, Sports & Spine physician Oluseun Olufade, MD.

With summer coming into full swing, a lot of us are out, about and getting more active. Some of our activities can lead to ankle sprains. Dr. Olufade discussed some common misconceptions about treating sprained ankles and exercises you can do to strengthen your ankles to help prevent sprains.

See all of Dr. Olufade’s answers by checking out the chat transcript! Here are just a few highlights from the chat:

Question: My son rolled his ankle this weekend at the beach. What do I need to do?

Oluseun Olufade, MDDr. Olufade: Great question! We use something called the RICE principle. Start with “R”est by staying off the foot, “I”ce the ankle for 20 minutes at a time every hour or two, use “C”ompression, like an Ace bandage, and “E”levate the foot as much as possible.

 

Question: What are some common mistakes that people make when they think they have an ankle sprain? In other words, what do people do to “treat” ankle sprains that can actually make them worse?

Oluseun Olufade, MDDr. Olufade: Ankle sprains can be associated with fractures. Some people try to “walk it off” if they think they have an ankle sprain, and without a proper diagnosis, you could actually be doing more damage to your ankle without knowing it.

If you do have an ankle sprain (not a fracture) I would recommend resting the injured ankle for 3-5 days. Some people worry and stay off of the foot for too long. Prolonged immobilization will make for a longer recovery. People often also make the mistake of using heat on the acute ankle sprain. Heat can actually worsen swelling, so ice packs are recommended instead of heat.

Question: How can you tell if you have a fracture and not just a sprain? Are there any additional symptoms other than increased pain?

Oluseun Olufade, MDDr. Olufade: Fractures are usually diagnosed by x-rays. You should see a doctor to confirm whether you have a fracture or not.
 
 
 
 
 
If you missed out on this live chat, be sure to check out the full list of questions and answers on the web transcript. You can also visit emoryhealthcare.org/ortho for a full list sports medicine treatments offered.

If you have additional questions for Dr. Olufade, fee free to leave a comment in our comments area below.

Find Out How to Prevent, Diagnose & Treat Ankle Sprains

Ankle Sprain

Did you know that more than 9 million Americans suffer an ankle sprain each year? Well, if you are one of these individuals or want to learn more about how to prevent an ankle sprain join us on Tuesday, May 27 for a live online chat on “Preventing, Diagnosing & Treating Ankle Sprains” with Emory Othopaedics, Sports & Spine physician Oluseun Olufade, MD. He will be available to answer questions related to a sprained ankle such as:

  • Can I prevent an ankle sprain?
  • What are the symptoms of an ankle sprain?
  • How do you diagnose an ankle sprain?
  • How do you treat an ankle sprain?
  • Why should I go to Emory for sports medicine care

Emory Orthopaedic, Sports & Spine physician Dr. Olufade is a dedicated non-surgical sports medicine specialist who can offer tips and suggestions to keep you healthy or get you back to health so you can get back to your normal active routine! Sign Up for the Chat Now!

What Should You Do When You Sprain Your Ankle?

Ankle SprainIt is estimated that 28,000 people injure their ankles every single day in the United States. This is mostly due to engaging in sports and is usually caused due to quick changes in direction, awkward landings from jumps, and stepping on another athlete’s foot.

If you have a suspected ankle sprain, you should see a doctor at the first opportunity to ensure proper diagnosis. Don’t try to just ‘walk off’ the injury and ignore it.

You can take an NSAID (nonsteroidal anti-inflammatory drug) to prevent the swelling from getting worse. Common NSAIDS include ibuprofen – such as Advil and Motrin, and naproxen – like Naprosyn. To manage pain immediately, take acetaminophen such as Tylenol. Just make sure to not do so on an empty stomach or exceed the recommended dosage.

After managing the pain, follow American Academy of Orthopedic Surgeons’ recommended RICE method to treat the sprain early:

  1.  Rest - Rest your ankle and use crutches till walking is no longer painful without them.
  2. Ice - Apply an ice pack (or improvise with a pack of frozen peas) for 20-30 minutes at a time. You can ice your ankle 3-4 times for the first couple days or until the swelling goes down.
  3. Compression - Use an elastic compression wrap (ACE wraps work well) for the first 2-3 days. Don’t apply the wrap too tightly. Signs that it is too tight are numbness, tingling, pain or swelling below the bandage.
  4. Elevation - Lay on the couch, bed or in the recliner with pillows propping up your leg so your ankle is above the level of your heart. This helps to prevent excess swelling and bruises.

Most ankle sprains will heal on their own if treated properly and the patient completes the exercises prescribed by the physician or physical therapist. Surgery is usually only needed when there are severe tears in the ligament or if a bone is broken. Make an appointment with a sports medicine specialist to evaluate the degree of the ankle sprain and discuss treatment options.

Chat Online with Dr. Olufade About Ankle Sprains

Ankle Sprain Q&A ChatIf you want to learn more about ankle sprains, join us on Tuesday, May 27 for a live online chat on “Preventing, Diagnosing & Treating Ankle Sprains” with Emory Orthopaedics, Sports & Spine physician Oluseun Olufade, MD. He will be available to answer questions related to the ankle such as:

  • What are the symptoms of an ankle sprain?
  • How do you diagnose an ankle sprain?
  • How do you treat an ankle sprain?

Sign Up for the Chat

About Dr. Olufade
Dr. Oluseun OlufadeDr. Olufade is board certified in Sports Medicine, Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team. Dr Olufade is also the team physician for Emory University and Blessed Trinity High School.

Dr. Olufade employs a comprehensive approach in the treatment of sports medicine injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in treatment of sports related concussions, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration. Dr. Olufade sees patients at our clinic at Emory Johns Creek Hospital.

Dr Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth
Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth. Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek. Mathew Pombo, MD and T. Scott Maughon, MD see patients in Duluth. Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine. To schedule an appointment call 404-778-3350.

Emory Sports Medicine patient, Susie Hemphill: A Story of Recovery

Susie HemphillIn August 2008 I fell and hurt my ankle. Over the course of four years, I was treated by two different orthopaedic surgeons and was not able to participate in tennis or any other sports. This was devastating for me because I am an avid and accomplished tennis player. I was recruited out of high school in Illinois to play collegiate tennis at the University of Alabama at Birmingham. But as a result of my ankle injury, I struggled to walk. I almost gave up hope that I would ever play again after two failed ankle surgeries. It was so hard to even perform daily tasks that I was contemplating applying for disability benefits. I was miserable with life because I was in so much pain on a daily basis.

According to Emory Orthopaedic surgeon, Dr. Sam Labib, I had a condition in my ankle where there was no cartilage between my foot and ankle bone. Dr. Labib gave me hope and said he could repair the damage by taking cartilage from my knee and putting it in my ankle. On, August 23, 2012, I had cartilage repair surgery at Emory Orthopaedics & Spine Center in Atlanta with Dr. Labib. It’s been a little over a year and a half since the surgery and I just keep getting better and better. Now, I am happy to say that I am pretty much as good as new and back to playing tennis as much as I want. I even recently made it to the City Finals playing Atlanta Lawn and Tennis Association AA1 Women’s Tennis. It is hard for me to believe that I was unable to do anything for almost four years.

Thanks to Dr. Labib, I am also now back to doing what I love professionally. I am a United States Professional Tennis Coach. It is so great to be back playing and coaching. I owe it all to Dr. Sam Labib. Dr. Labib is a caring, compassionate, exceptional, talented, driven doctor and I owe him the world for fixing me and giving my life back. I highly recommend Dr. Labib to any patient who has a similar condition.

About Dr. Sameh (Sam) Labib

Dr. Sameh Labib

Sam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com. Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University and Spelman College, and an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

About Emory Sports Medicine
The Emory Sports Medicine Center is a leader in advanced treatments for patients with orthopedic and sports-related injuries. From surgical sports medicine expertise to innovative therapy and athletic injury rehabilitation, our sports medicine physicians and specialists provide the most comprehensive treatment for athletic injuries in Atlanta and the state of Georgia. Constantly conducting research and developing new techniques, Emory sports medicine specialists are experienced in diagnosing and treating the full spectrum of sports injuries.
Our sports medicine patients range from professional athletes to those who enjoy active lifestyles and want the best possible outcomes and recovery from sports injuries. Our doctors are the sports medicine team physicians for the Atlanta Falcons and Georgia Tech and provide services for many additional professional, collegiate and recreational teams. Appointments for surgical second opinions or acute sports injuries are available within 48 hours. Call 404-778-7777 for an appointment.

Related Links

When it Comes to Your Health, are High Heels Worth the Price of Looking Good?

High Heels Back PainEmory Orthopaedics, Sports and Spine physicians Kyle Hammond, MD  and Oluseun A. Olufade, MD recently participated in “Ladies Night Out”  at Emory Johns Creek Hospital.

The Ladies Night Out event is an annual health fair held by Emory Johns Creek Hospital for women to talk with physicians and other providers in the Johns Creek and North Atlanta communities and learn about services near them.

At the Emory Orthopaedics, Sports & Spine table, Drs. Hammond and Olufade spoke with women about potential injuries that could occur from wearing high heeled shoes and what women might be able to do to help prevent injuries to their backs, ankles, feet, hips and knees.

As a fun activity at the Ladies Night Out event, we also had a free drawing for high heeled shoes that were displayed at the table.  Five lucky women went home with a new pair of shoes and lots of tips to prevent orthopedic injuries.

Emory Orthopaedics and Spine Team at the Ladies Night Out Event
Below are 5 orthopedic conditions or injuries related to wearing high heels and tips on how you can prevent them:

ACHILLES TENDINITIS

Symptom: Pain & swelling in lower calf and heel cord resulting in decreased calf flexibility

Achilles Tendinitis Prevention:

  •  Calf stretches with towel or band
  • Calf raises / strengthening exercises
  • Heel pads
  • Wear short heels or flats

ANKLE SPRAIN / FRACTURE

Symptom: Pain, bruising, swelling and inability to walk

Ankle Sprain & Fracture Prevention:

  • Wear short, wide heels (no stilettos)
  • Single leg balancing
  • Ankle ‘A, B, Cs’

BUNIONS

Bunion Symptom: Tenderness and prominence inside of the big toe joint

Bunion Prevention:

  • Ensure proper shoe size & fit
  • Wear short heels with wide toe box
  • Use pads to cushion bunions
  • Wear heels for brief periods of time if possible

KNEE AND HIP INJURIES

Symptom: Muscles in your hip and knee have to work harder when you wear heels as muscles become fatigued and more prone to injury

Possible Injuries:

  • Muscle strain
  • Tendinitis
  • Meniscus tear
  • Hip impingement

Hip & Knee Injury Prevention:

  • Stretch hamstrings, quads, & hip
  • Strength training for lower body
  • Alternate heels with flats during the work week
  • Balance exercises

LOW BACK PAIN

Low Back Pain Causes: Normal center of gravity changes, increasing the curvature of your low back and tilting your pelvis forward.

Low Back Pain Prevention:

  • Change into flats for long walking distances
  • Strengthen your core (crunches & low back extension exercises)

Although high heels look nice and are fun to wear at special events, try to limit the high heels to special occasions and stick with flats for your day to day activities.  Your body will thank you!

About Dr. Kyle Hammond

Dr. Hammond is an orthopaedic surgeon new to the Emory Orthopaedics faculty.  He recently completed his fellowship at the University of Pittsburgh Medical Center.  While at the University of Pittsburgh he was the Associate Head Team Orthopaedic Surgeon for both the Duquesne University Football team and the University of Pittsburgh Men’s Basketball team.  He also worked as a Team Physician for the Pittsburgh Steelers, the Pittsburgh Penguins, the University of Pittsburgh athletics, Robert Morris College athletics, as well as the Pittsburgh Ballet.

Dr. Hammond sees patients at Emory Johns Creek Hospital, as well as Emory Orthopaedics & Spine Center in Atlanta.  Dr. Hammond has a special interest in the overhead/throwing athlete, ligament injuries to the knee, Tommy John surgery, joint preservation surgery, and is one of the few fellowship trained hip arthroscopists and concussion specialists in Georgia.

About Dr. Oluseun A. Olufade

Dr. Olufade is board certified in Physical Medicine & Rehabilitation and Interventional Pain Medicine. He completed fellowship training in both Sports Medicine and Interventional Pain Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team.

Dr. Olufade employs a comprehensive approach in the treatment of  sports related injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in concussion, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration. Dr. Olufade sees patients at Emory Johns Creek Hospital.

About Emory Ortho, Sports and Spine in Johns Creek and Duluth

Emory Orthopaedics, Sports & Spine has recently opened two new clinics, one in Johns Creek and one in Duluth.  Emory physicians, Kyle Hammond, MD, and Oluseun A. Olufade, MD see patients in Johns Creek.  Mathew Pombo, MD and T. Scott Maughon see patients in Duluth.  Our new clinic locations care for a full range of orthopedic conditions including: sports medicine, hand/wrist/elbow, foot/ankle, joint replacement, shoulder, knee/hip, concussions, and spine.

To schedule an appointment call 404-778-3350

Related Resources:

Is it a Sprain? Or a Fracture?

Dr. Rami Calis
When you injure your ankle, it may be hard to tell whether you’ve sprained it (stretched or torn a tendon or ligament) or fractured it (broken a bone). Generally speaking, here are some things to keep in mind:

  • If you have pain around the soft tissue areas but not over the bone, you probably have a sprain, not a break.
  • If you have pain over the ankle bone, you most likely have a break.
  • If you’re not able to walk on it, there’s a good chance you have a break.

If you’ve hurt your ankle but you’re not sure it’s serious, a general rule of thumb is to watch it for two to four days and use the RICE method—REST your ankle, put an ICE pack on it, use COMPRESSION, such as an Ace bandage or air cast (available at your local drugstore) to stabilize it, and ELEVATE it. If, after two to four days, you still have significant pain or difficulty putting weight on your foot, or you see black and blue marks or blisters, it’s time to see a doctor.

At the Emory Orthopaedics & Spine Center, our orthopedic specialists are experts at diagnosing and treating foot and ankle injuries. We use our clinical knowledge, an MRI when needed (we have the only 3-tesla MRI in the state—think of it as an MRI in HD), and X-rays to help determine whether you’ve fractured a bone or torn a ligament and whether the injury requires surgery. Most ankle injuries, whether fractures or sprains, can be treated conservatively, without surgery. However, if a fracture calls for surgery, we may use a plate and screws on the side of the bone or a screw or rod inside the bone to realign the bone fragments and stabilize them as they heal. Sometimes a soft tissue injury will require surgical intervention, as well, as it may create ankle instability and need to be repaired. However, most cases will do well with conservative care and physical therapy to follow.

When you see your doctor after an ankle injury, it’s important to describe in detail how the injury occurred. Did your foot turn under, out, in, or rotate? The more you can tell us, the more effectively we’ll be able to diagnose and treat your injury. Any information you can tell us is useful. At Emory Orthopaedics & Spine Center, we focus on listening to the patient and tailoring a treatment plan that fits the patient, without compromising care or adequate healing time.

If you’ve sprained your ankle in the past and now find that it twists easily or feels weak, you may have damaged the ligaments, causing chronic ankle instability. Although you may not feel any pain originally, over time you may develop arthritis in your ankle. At Emory, we can try to implement physical therapy for ankle strengthening, but if that fails, it may be necessary to repair the ligaments so that your ankle is stabilized.

Remember—if your ankle hurts, don’t push it. There’s a reason your body is talking to you, so get it looked at by a doctor. Our goal is to keep you active for the long term not just the short term. The worst thing you can do is to try to push through the pain and ignore your body’s communication, as that may lead to long-term ankle joint disability and arthritis. It’s not uncommon for an ankle sprain to be painful for many months after an injury, and swelling may last for four months to a year, but if it still hurts to put weight on it two to three weeks after you’ve injured it, make an appointment at the Emory Orthopaedics & Spine Center to see a foot and ankle specialist.

Have you sprained or broken your ankle? Have you had an ankle injury that required surgery? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Rami Calis, DPM:

Rami Calis, DPM, is assistant professor in the Department of Orthopedics. He is board certified and a Diplomate, American Board of Podiatric Orthopedics and Primary Podiatric Medicine, with an interest in sports medicine of the lower extremity and foot and ankle biomechanics. Dr. Calis holds clinic and does surgery at Emory Orthopaedics & Spine Center at Executive Park and also holds clinic in Duluth, at our satellite office. Dr. Calis’ professional goal is to improve patient care and quality of life for patients with foot and ankle problems. Dr. Calis began practicing at Emory in 2003.