Talus Fracture of the Ankle

The talus is one of the major bones that form the ankle joint and serves as an important link between the leg and foot. It's also a unique bone, as it's over half covered with cartilage that provides cushion and allows bones to move more freely against each other.

The talus contributes to motion not only at the ankle joint but also below the ankle at the subtalar joint and in the midfoot at the talonavicular joint. 

Injuries to the talus can have a significant effect on the motion of your ankle and foot joints and limit your ability to walk and bear weight.

Talus fractures are most often seen in car and motorcycle crashes, snowboarding accidents, and severe falls.

Symptoms

Talus fracture causes significant ankle pain, difficulty bearing weight on the ankle, and swelling around the ankle joint. These symptoms warrant going to the doctor right away.

Expect to have an X-ray and ankle exam to determine whether it's a fracture or other type of injury.

The most common symptoms of talus fractures include:

• Swelling around the ankle joint
• Pain with movement of the ankle
• Fracture blisters
• Bruising of the skin
• Inability to place weight on the joint

Treatment Options

Treatment of a talus fracture depends on the extent of the injury.

If the fracture is not out of position, a cast may be sufficient for treatment.

If the fracture is out of position, then surgery may be recommended to realign the broken bones and stabilize them with screws or pins.

Complications

Three major complications commonly occur with talus fractures:

• Ankle arthritis
• Malunion
• Osteonecrosis

Other potential problems include infection, nonunion, foot deformity, and chronic pain.

Ankle Arthritis

Arthritis is common after a talus fracture because when the cartilage is injured, the normally smooth joint surface becomes uneven. These irregularities can lead to accelerated wear in the joint, and ultimately to arthritis.

Because so much of the bone is covered with cartilage, arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint.

Even with surgical treatment of a talus fracture, the development of arthritis is common.

Malunion

Malunion means that the break has healed, but the position where the bone healed is not anatomically correct.

This can lead to a number of different problems, especially with foot fractures where altered alignment can lead to long-term problems and difficulty walking.

Osteonecrosis

Osteonecrosis, or avascular necrosis, is a problem that is found commonly in the talus.

Because of the pattern of blood supply to the talus bone, it can be disrupted when the bone is injured in a fracture. Without a blood supply, the bone cells can die (osteonecrosis) and lead to a collapse of the bone.

Even with surgery to realign the bone and hold the fragments in position, damaged blood supply may lead to this problematic complication.

Recovery

The recovery from a talus fracture can be lengthy because until the bone is healed, you cannot place weight on your foot.

Therefore, most talus fractures require a minimum of six to 12 weeks of protection from weight-bearing. In more significant injuries, the time may be longer.

Studies have shown that the ultimate outcome of patients correlates with the extent of the initial injury. (So the worse the injury, the more on-going issues you're likely to have.)

During or after the healing process, your doctor may start you on a rehab program of physical therapy to regain: 

• Range of motion
• Stability
• Strength

You may have to use a cane or wear a special boot and may not be able to put your full weight on your foot for two to three months.