Talus Fractures - OrthoInfo - AAOS (2022)

A talus fracture is a break in one of the bones that forms the ankle. This type of fracture often occurs during a high-energy event, such as a car collision or a fall from a significant height.

Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. A talus fracture that does not heal properly can lead to complications, including a limp, arthritis, and chronic pain. For this reason, most talus fractures require surgery.

The talus is the bone that makes up the lower part of the ankle joint (the tibia and fibula make up the upper part). The ankle joint allows your foot to move up and down. The talus also sits above the heel bone (calcaneus). Together, the talus and calcaneus form the subtalar joint. This joint allows your foot to move inward and outward, which is important for walking on uneven ground.

The talus is the main connector between the foot and leg, helping to transfer weight and pressure forces across the ankle joint. It is largely covered by articular cartilage, the white slippery material that covers all joint surfaces. This cartilage allows the talus to move smoothly against its neighbor bones.

Talus Fractures - OrthoInfo - AAOS (1)

The talus bone sits between the bones of the lower leg and the calcaneus (heel bone).

Fractures can occur in all parts of the talus bone. Most commonly, the talus breaks in its mid-portion, called the "neck." The neck is between the "body" of the talus, under the tibia, and the "head" of the talus, located further down the foot.

Talus Fractures - OrthoInfo - AAOS (2)

(Video) Talus Fractures An Overview to Diagnosis and Management by Robert B. Anderson, MD

The talus often breaks in the mid-portion — or "neck" — of the bone. This illustration shows a displaced talus neck fracture.

Reproduced and modified with permission from Fortin PT, Balazsy JE: Talus fractures: evaluation and treatment. J Am Acad Orthop Surg 2001; 9:114-127.

The talus may also fracture through a prominence on the outside of the bone called the lateral process. Lateral process fractures occur when the ankle is forced out to the side and are commonly seen in snowboarders.

Talus fractures can be classified by how much the pieces of bone have moved out of their normal position.

Minimally displaced or stable fractures:This type of fracture is barely out of place. The broken ends of the bones line up correctly or almost correctly. In a minimally displaced fracture, the bones usually stay in place during healing. Surgery to repair the bones is not required.

Displaced fracture. A displaced fracture occurs when the bone breaks and the pieces move out of their anatomic position. The amount of displacement relates to the force of the injury. Highly displaced fractures are more likely to be unstable. They often require surgery to restore the alignment and give the best chance for a return to normal function of the foot and ankle.

Open fracture:When broken bones break through the skin, the injury is called an open or compound fracture. Open fractures often involve greater injury to the surrounding muscles, tendons, and ligaments. In addition, open fractures expose the fracture site to the environment, allowing debris from the outside to penetrate the wound. For this reason, they have a higher risk of infection and often take a longer time to heal.

Most talus fractures are the result of high-energy trauma such as a car collision or a fall from height. Injuries from sports, particularly snowboarding, are another, though less common, cause of talus injuries.

Patients with talus fractures usually experience:

  • Acute pain
  • Inability to walk or bear weight on the foot
  • Considerable swelling, bruising, and tenderness

Most people with talus fractures will go to an urgent care center or emergency room for initial treatment because of the severity of their symptoms.

Physical Examination

After reviewing your symptoms and medical history, your doctor will do a careful examination. During the exam, he or she will:

  • Examine your foot and ankle carefully to see if there are any cuts from the injury.
  • Check to see if you can move your toes, and can feel things on the bottom of your foot. In some cases, nerves may be injured at the same time that the bone is broken.
  • Check your pulse at key points of the foot to be sure that there is good blood supply to the foot and toes.
  • Check to see that pressure from fluids is not building up in the muscles of the leg, a condition called compartment syndrome. Compartment syndrome can result in loss of sensation and function, and requires emergency surgery once it is diagnosed.
  • Determine if you have any other injuries by examining the rest of your injured foot, as well as your legs, pelvis and spine.

Imaging Tests

Information from diagnostic imaging tests will help your doctor decide whether surgery is required and will be critical for surgical planning.

  • X-rays. X-rays are the most common and widely available diagnostic imaging technique. An x-ray can show if the bone is broken and whether there is displacement (fragments are out of place). It can also show how many pieces of bone there are.

Talus Fractures - OrthoInfo - AAOS (3)

An x-ray of a talus neck fracture.

Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. Rosemont, IL American Academy of Orthopaedic Surgeons, 2004, p. 605.

  • Computerized tomography (CT) scan. If your doctor still needs more information after viewing your x-rays, a CT scan may also be ordered. A CT scan shows a cross-sectional image of your foot. It can provide valuable information about the severity of the fracture by helping your doctor see the fracture lines more clearly.
(Video) Osteochondral Lesions of the Talus by Dr Darren Webb

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Immediate first aid treatment for a talus fracture, as with any painful ankle injury, is to apply a well-padded splint around the back of the foot and leg to immobilize and protect the limb. The splint should extend from the toe to the upper calf. Elevating the foot above the level of the heart helps to minimize swelling and pain. Specific treatment depends upon the severity and the type of fracture, so it is important to seek immediate medical attention.

Nonsurgical Treatment

Many talus fractures require surgery because of the high-energy force that creates the injury. Stable, well-aligned fractures, however, can often be treated without surgery. This is usually done with a combination of immobilization and then rehabilitation.

Casting. A cast will hold the bones in your foot in place while they heal. You will have to wear a cast for 6 to 8 weeks. During this time, you will be asked to limit the amount of pressure you put on your foot. The goal is for the bone to heal enough for you to bear weight on it without the risk that it will move out of position.

Rehabilitation. When the cast is removed, your doctor will give you exercises to help restore range of motion and strengthen your foot and ankle.

Surgical Treatment

If the bones have shifted out of place (displaced), surgery to internally set and stabilize the broken pieces results in the best outcome and reduces the risk of future complications.

Open reduction and internal fixation. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are then held together with special screws or metal plates and screws.

Talus Fractures - OrthoInfo - AAOS (4)

(Left) This x-ray shows a talus fracture. (Right) The bone fragments are fixed in place with screws.

Reproduced with permission from Fortin PT, Balazsy JE: Talus fractures: evaluation and treatment. J Am Acad Orthop Surg 2001; 9:114-127.

(Video) Pan Talar Arthrodesis

Bones have a remarkable capacity to heal. The more severe your injury, however, the longer your recovery may be. After surgery, your foot will be in a splint or cast from 2 to 8 weeks. This depends on the nature of the injury and how well the healing progresses. Your doctor will take x-rays to ensure that the bones stay in position and are healing properly.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Early Motion

Many doctors encourage motion of the foot and ankle early in the recovery period, as soon as your pain allows. Patients who have had surgery are instructed to begin moving the affected area as soon as the wound heals. Patients who are treated without surgery will work on regaining motion in the foot and ankle after the cast is removed.

Physical Therapy

Specific physical therapy exercises can improve the range of motion in your foot and ankle, and strengthen supporting muscles.

Weightbearing

When you begin walking, you may need to use a cane or crutches and wear a special boot. You will not be able to put all of your weight on your foot for up to two to three months. If you place too much weight on your foot too soon, the bone pieces may move out of place. Be sure to follow your surgeon's directions. As your break heals and your pain improves, you will be allowed to put more pressure on your foot.

Avascular Necrosis (AVN)

With unstable talus fractures, the blood supply to the bone can be disrupted at the time of the injury. Sometimes, the blood supply simply returns to the bone and normal healing begins. In other cases, however, the bone cells die without a blood supply, leading to a gradual and very painful collapse of the bone. This condition is called avascular necrosis (AVN) or osteonecrosis.

When the bone collapses, the articular cartilage covering the bone is also damaged. Without this smooth cartilage, bone rubs against bone, leading to increased pain, arthritis and loss of motion and function. The more severe the talus fracture, the more likely it is that AVN will occur. Even fractures that are treated appropriately, including those that are treated surgically, may develop AVN.

Posttraumatic Arthritis

Posttraumatic arthritis is a type of arthritis that develops after an injury. Even when your bones heal normally, the cartilage protecting the bones can be damaged, leading to pain and stiffness over time. The majority of talus fractures result in some degree of posttraumatic arthritis. In cases of extreme arthritis or avascular necrosis that limit activity, additional surgery, such as a joint fusion or ankle replacement, may be the best option to relieve symptoms.

(Video) Malleolar ankle fractures - Lauge Hansen types (OTA lecture series III l12b)

FAQs

Can you walk with a fractured talus bone? ›

What is the long-term prognosis for a talus fracture? With or without surgery, your foot will be in a cast or splint. You won't be able to put any weight on it or walk on it. Depending on the complexity of your injury, you may have to wear the cast for eight to 12 weeks or more.

How long does it take to heal a fractured talus? ›

You will have to wear a cast for 6 to 8 weeks. During this time, you will be asked to limit the amount of pressure you put on your foot. The goal is for the bone to heal enough for you to bear weight on it without the risk that it will move out of position.

How serious is a talus fracture? ›

Talus fractures are quite severe injuries and can lead to longstanding problems with the foot and ankle. There are early and late complications. Early complications most often are related to the significant swelling that can occur after these injuries, which can cause wound problems and infection.

Can a fractured talus heal without surgery? ›

In rare cases, if the bones haven't moved out of place, a talar fracture can be treated without surgery. You will have to wear a cast and avoid putting weight on your foot for six to eight weeks.

Can you run after a talus fracture? ›

In general, you can attempt to start running about three to four months after your injury. By this time, the bones in your ankle should be well healed and your ROM and strength should be close to normal.

How do you speed up bone fracture healing? ›

The three key steps to faster bone healing are:
  1. Alignment of the broken bone fragments.
  2. Stability and support at the fracture site through immobilization.
  3. Healthy lifestyle choices that promote healing.
Feb 10, 2021

When can I walk after talus fracture? ›

​Recovery can be prolonged. No weight or walking on the leg will be allowed for 8-12 weeks. Once the bone is healed, exercise and physical therapy is started to maximize the function of the ankle. The patient should expect some swelling about the foot for several months after the procedure.

What happens if talus bone dies? ›

Avascular necrosis of the talus can be quite devastating and lead to total loss of the ankle joint with arthritis, deformity and pain. The development of AVN is determined to a large extent by the type of the talus fracture.

Is talus a weight-bearing bone? ›

The talus (astragalus) articulates above with the bones of the lower leg to form the ankle joint. The other six tarsals, tightly bound together by ligaments below the talus, function as a strong weight-bearing platform.

How do you get a talus fracture? ›

A talus fracture usually results from serious trauma to the foot. Injuries that could cause a talus fracture include a fall from a great height or a car accident. A badly twisted ankle can also cause small pieces of the talus to break off. If the fracture doesn't heal properly, you could have walking problems.

How do you get rid of talus pain? ›

Nonsurgical Treatment Approaches
  1. Immobilization. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. ...
  2. Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  3. Physical therapy. ...
  4. Ankle brace.

Is the talus a foot or ankle bone? ›

The talus is the bone at the top of the foot that serves as a perch for the tibia and holds the weight of the entire body. The talus is considered a short bone and is one of the main bones of the ankle.

How common is a talus fracture? ›

Although Talar body fracture is more common than Talar head fractures, they are rare nevertheless and account for 0.62% of all fractures that are treated. These fractures often occur from high-energy impact such as motor vehicle accidents.

Why a boot and not a cast? ›

Less skin damage – skin underneath a cast can become raw and painful. The open-air design and lightweight material helps to prevent skin damage when wearing a walking boot. No loud saws used – walking boots can be removed without the use of loud saws. This is helpful for children who may be afraid of the saws.

Will my broken ankle ever be the same? ›

If it's a low-to-medium grade ligament injury or a stable bone fracture, then it's highly likely that the ankle will be similar to before. With more severe ligaments and unstable fractures, there is always some difference in flexibility and appearance.

Can I go to the gym with a fractured ankle? ›

Most people will return to everyday movements (except athletics) within three to four months following a fracture. Everyone's circumstances are different, but it can take several months or more before you'll feel comfortable again to participate in sports such as running.

Does vitamin D Help fracture healing? ›

Standardized scans for bone mineral density (BMD) over the fracture area were similar at baseline but showed significantly higher BMD levels in the active group by week 6. They concluded that supplementation of vitamin D3 and calcium had a positive influence on fracture healing in women with reduced bone mass.

Which vitamin helps rebuild bone after a fracture? ›

Vitamin C helps your body make collagen, which helps your bone fracture heal. You can get it from many tasty, fresh fruits and veggies. Aged or heated produce can lose some of its vitamin C, so go for fresh or frozen.

Does drinking water help heal broken bones? ›

As your bones lose minerals and need to rebuild and strengthen, a lack of available calcium can lead to bone loss and eventually osteoporosis. Since water also helps rid the body of toxins, these substances can and do build up in the bones if there is not enough water to carry them away.

Why does my talus hurt when walking? ›

Osteochondral lesions of the talus (OLT):

A sudden injury can damage the cartilage present on top of the Talus bone (heel bone). It usually happens after an injury like an ankle sprain. If the cartilage fails to heal properly after the injury, it begins to break off and lead to OLT or Talar dome lesion.

What type of bone is the talus? ›

The talus is the second largest of the tarsal bones; it is also one of the bones in the human body with the highest percentage of its surface area covered by articular cartilage.
...
Talus bone
Subtalar Joint, viewed from an angle between lateral and frontal.
Details
Identifiers
LatinOs talus, Astragalus
6 more rows

How do you fix talus bones? ›

Most of the time fractures involving the talus require surgery. However, if the fracture is in a good alignment and seems stable, you might be treated without surgery using a splint or cast. If the bones are shifted out of place, surgery is usually needed to reset the bones.

What is OCD of the talus? ›

An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL).

Why is the talus a key bone of the ankle? ›

The talus is the key bone of the foot due to its location between the ankle and the subtalar joints. Through the flexion and extension of the ankle joint, the talus is the "propulsive bone" situated at the root of the first ray and the hallux.

What muscle attaches to talus? ›

No muscles are attached to the talus but many ligaments are attached to the bone, creating stability in the ankle, subtalar and calcaneonavicular joints. On the lateral side, the joint is held together by the posterior talofibular and anterior talofibular ligaments.

What is the talus also known as? ›

The talus (plural: tali 4), also known as the astragalus 4, is a tarsal bone in the hindfoot that articulates with the tibia, fibula, calcaneus, and navicular bones. It has no muscular attachments and around 60% of its surface is covered by articular cartilage.

Where does a talus fracture hurt? ›

Talus fracture causes significant ankle pain, difficulty bearing weight on the ankle, and swelling around the ankle joint.

Is walking good for ankle pain? ›

Resting your feet wherever possible by not running, walking or standing for too long can help to avoid any more inflammation. Wearing comfortable shoes with good arch support will also reduce the strain on your feet. Painkillers such as paracetamol and ibuprofen can help to control the pain.

How can I make my ankle heal faster? ›

Treatment
  1. Rest. Avoid activities that cause pain, swelling or discomfort.
  2. Ice. Use an ice pack or ice slush bath immediately for 15 to 20 minutes and repeat every two to three hours while you're awake. ...
  3. Compression. To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. ...
  4. Elevation.
Apr 27, 2021

What exercise is good for ankle pain? ›

Ankle Rotations

Raise your foot about 20 inches off the floor. Then with your toe upward, rotate the foot to the left and then back to the right. Hold for 10 seconds then return to starting position. Repeat 20 times for each leg.

What is the main function of the talus? ›

The talus is the second largest bone in the hindfoot region of the human body. Responsible for transmitting body weight and forces passing between the lower leg and the foot. Is a component of many multiple joints, including the talocrural (ankle), subtalar, and transverse tarsal joints.

Why does my talus hurt when walking? ›

Osteochondral lesions of the talus (OLT):

A sudden injury can damage the cartilage present on top of the Talus bone (heel bone). It usually happens after an injury like an ankle sprain. If the cartilage fails to heal properly after the injury, it begins to break off and lead to OLT or Talar dome lesion.

Is the talus bone weight-bearing? ›

The talus (astragalus) articulates above with the bones of the lower leg to form the ankle joint. The other six tarsals, tightly bound together by ligaments below the talus, function as a strong weight-bearing platform.

What happens if talus bone dies? ›

Avascular necrosis of the talus can be quite devastating and lead to total loss of the ankle joint with arthritis, deformity and pain. The development of AVN is determined to a large extent by the type of the talus fracture.

How do you pop a talus bone? ›

How to SELF Adjust Your Ankles - YouTube

Should I keep walking with ankle pain? ›

Rest: If you've had an injury such as a sprain, you should stay off your feet for a while. Talk to your provider about how long you should rest. Crutches or a walking boot can help you get around without putting weight on your ankle.

How can I make my ankles stronger after an injury? ›

Push-up: Sitting in the same chair, place your healthy foot in top of your injured foot and gently push down while pushing up with the injured foot. Hold for 3 seconds. Towel-stretch: While standing, gently pull a towel toward you while keeping your knee straight. Hold this position for 15-30 seconds.

What exercise is good for ankle pain? ›

Ankle Rotations

Raise your foot about 20 inches off the floor. Then with your toe upward, rotate the foot to the left and then back to the right. Hold for 10 seconds then return to starting position. Repeat 20 times for each leg.

How common is a talus fracture? ›

Although Talar body fracture is more common than Talar head fractures, they are rare nevertheless and account for 0.62% of all fractures that are treated. These fractures often occur from high-energy impact such as motor vehicle accidents.

Why is the talus important? ›

The talus is the main bone that connects the ankle with the lower leg. The talus serves as the connection point for several bones and takes on a lot of force when twisting or sudden weight is applied to the foot and ankle.

Which muscles attach to talus? ›

No muscles are attached to the talus but many ligaments are attached to the bone, creating stability in the ankle, subtalar and calcaneonavicular joints. On the lateral side, the joint is held together by the posterior talofibular and anterior talofibular ligaments.

How do you fix talus bones? ›

Most of the time fractures involving the talus require surgery. However, if the fracture is in a good alignment and seems stable, you might be treated without surgery using a splint or cast. If the bones are shifted out of place, surgery is usually needed to reset the bones.

What is OCD of the talus? ›

An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL).

Why is the talus a key bone of the ankle? ›

The talus is the key bone of the foot due to its location between the ankle and the subtalar joints. Through the flexion and extension of the ankle joint, the talus is the "propulsive bone" situated at the root of the first ray and the hallux.

How do you stretch a talus? ›

Sit with your towel or band around your left foot. Firmly hold each end of the towel with your hands. This time, slowly turn your ankle outward, like you're facing the sole of your foot to the left. Then pull up with the left-hand side of your towel to deepen the stretch.

How do you do a talar tilt test? ›

The Talar Tilt Test | Lateral Ankle Sprain - YouTube

Why do my ankles snap when I walk? ›

You have three peroneal muscles on the outside part of your lower leg. These muscles stabilize your ankle joint. Two of these muscles run through a groove behind the bony bump on the outside of your ankle. If the tendons from these muscles slip out of this groove, you may get a snapping or popping sound and feeling.

Videos

1. Osteochondral Lesions of the Talus - Talk by Dr. Craig Radnay
(Craig S. Radnay, MD)
2. Talus bone
(Audiopedia)
3. 11am - Neglected Foot & Ankle Injuries: Ankle, Calcaneus, Talus
(Selene Parekh MD)
4. Balancing AO Principles in Calcaneus Fractures
(UW Video)
5. Intra articular Calcaneus Fractures Updates on Management
(Husky Orthopaedics)
6. IOACON 2020 Bounce Back Webinar Series: The Tibial Plafond Demystified!!
(Ortho TV : Orthopaedic Video Channel)

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