The 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.
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.
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 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, 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.