Talus Fracture

What is it?
The talus (TAY-lus) is a small bone that sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). It has an odd humped shape, somewhat like a turtle. The bones of the lower leg "ride" on top and around the sides to form the ankle joint. Where the talus meets the bones of the foot, it forms the subtalar joint, which is important for walking on uneven ground. 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.

Most injuries to the talus result from motor vehicle accidents, although falls from heights also can injure the talus. These injuries are often associated with injuries to the lower back. An increasing number of talar fractures result from snowboarding, which uses a soft boot that is not rigid enough to prevent ankle injuries.

Signs and Symptoms

  • acute pain
  • an inability to bear weight
  • considerable swelling and tenderness

A fracture that breaks through the skin has an increased risk of infection. Talar fractures that result from snowboarding injuries may be mistaken for ankle sprains because of the tenderness on the outer side of the ankle and severe bruising.

Diagnosis
Our doctor will examine your foot and ankle and ask you to describe how the injury occurred. He will order X-rays of your foot and ankle. In some cases, the X-ray will not show the fractures, so a computed tomography (CT) scan may be needed. These diagnostic tests will help pinpoint the location of the fracture. They also will show whether the bones are still aligned (non displaced fracture) or have shifted out of place (displaced fracture). Any loose bits of bone that may need to be removed can be identified.

Our doctor will check the functioning of the nerves to the foot to ensure that there is no damage. He will make sure that an adequate supply of blood is flowing to the toes and that pressure is not building in the muscles of the foot (compartment syndrome).

Treatment
A fracture of the talus that is left untreated or that doesn't heal properly will create problems for you later. Your foot function will be impaired, you will develop arthritis and chronic pain, and the bone may collapse. Immediate first aid treatment for a talar fracture is to apply a well-padded splint around the back of the foot and leg from the toe to the upper calf. Elevate the foot above the level of the heart and apply ice for 20 minutes every hour or two until you can see a doctor. Don't put any weight on the foot.

In rare cases, a talar 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. Afterwards, your doctor will give you some exercises to help restore the range of motion and strength to your foot and ankle. Most fractures of the talus require surgery to minimize later complications. Our 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 used to restore the structural integrity of the joint.