(Also known as Talar Fracture, Talar Dome Fracture, Fractured Talus, Broken Talus)
What is a talus fracture?
A talus fracture is a condition characterized by a break in one of the small bones of the ankle, known as the talus.
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot. The talus is situated below the tibia and fibula (lower leg bones) and connects with these bones to form the ankle joint. The talus bone also forms joints with several other small bones of the foot including the navicular and calcaneus.
During certain activities such as landing from a jump, or when rolling an ankle, stress is placed on the talus bone. When this stress is traumatic, and beyond what the bone can withstand, a break in the talus may occur. This condition is known as a talus fracture.
Because of the large forces required to break the talus bone, this condition often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Talus fractures can vary in location, severity and type including stress fracture, displaced fracture, un-displaced fracture, comminuted fracture etc.
Causes of a talus fracture
A talus fracture often occurs in association with a rolled ankle particularly when significant weight bearing forces are involved. They may also occur due to an awkward landing from a jump (particularly on uneven surfaces) or due to a fall from a height. Talus fractures may occur in running and jumping sports involving change of direction such as football, soccer, rugby, basketball and tennis. A stress fracture to the talus, may occur as a result of overuse often associated with a recent increase or high volume of running.
Signs and symptoms of a talus fracture
Patients with a talus fracture typically experience a sudden onset of sharp, intense ankle pain at the time of injury. This often causes the patient to limp so as to protect the talus. In severe cases, particularly involving a displaced fracture of the talus, the patient will be unable to weight bear. Pain is usually felt at the front of the ankle although symptoms may be felt in the sides or back of the ankle. Symptoms may settle quickly with rest leaving patients with an ache at the site of injury that may be particularly prominent at night or first thing in the morning.
Patients with a talus fracture may also experience swelling, bruising and pain on firmly touching the affected region of the ankle. Pain may also increase during certain movements of the foot or ankle or when standing or walking (particularly up hills or on uneven surfaces) or when attempting to stand or walk. Occasionally patients may also experience pins and needles or numbness in the ankle, foot or toes.
Diagnosis of a talus fracture
A thorough subjective and objective examination from a doctor is essential to assist with diagnosis of a talus fracture. An X-ray is usually required to confirm diagnosis and assess the severity. Further investigations such as an MRI, CT scan or bone scan may also be required to assist with diagnosis and assess the severity of the injury.
Treatment for a talus fracture
For those talus fractures that are displaced, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anaesthetic) followed by surgical internal fixation to stabilize the fracture (e.g. use of screws). If loose fragments are present within the ankle joint, arthroscopic removal of fragments may be indicated. Surgery may be followed by the use of a protective boot, brace, plaster cast and/or crutches for a number of weeks.
For those fractures that are not displaced, treatment may involve the use of crutches and/or a protective boot or brace, or, plaster cast immobilization and the use of crutches, followed by the use of a protective boot or brace for a number of weeks. The orthopedic specialist will advise the patient as to which management is most appropriate based on a number of factors, including the location, severity and type of the fracture.
Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed, rehabilitation can progress as guided by the treating doctor.
One of the most important components of rehabilitation following a talus fracture is that the patient rests sufficiently from any activity that increases their pain (crutches and / or a protective boot are often required). Activities which place large amounts of stress through the talus should also be avoided, particularly excessive weight bearing activity such as running, jumping, standing or walking excessively (especially up hills or on uneven surfaces). Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities and weight bearing forces is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the talus fracture altogether.
Patients with a fractured talus should perform pain-free flexibility, strengthening and balance exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as balance, soft tissue flexibility and strength are quickly lost with inactivity. Hydrotherapy exercises and cycling may also be indicated. The treating doctor can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation, a gradual return to activity or sport can occur as guided by the treating therapist provided there is no increase in symptoms.
It may be advised upon returning to some sports, particularly those sports requiring rapid change of direction, such as football and netball, that the ankle is either taped or braced for additional support or protection. The treating therapist or doctor can advise if this is recommended.
Prognosis of a talus fracture
Patients with a fractured talus usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in a number of weeks to many months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.
Patients with severe talus fractures or those that are not managed appropriately may have an increased likelihood of developing ankle arthritis.
Physical therapy for a talus fracture
Physical therapy treatment is vital in all patients with a talus fracture to hasten healing and ensure an optimal outcome. Treatment may comprise:
Other intervention for a talus fracture
- soft tissue massage
- joint mobilization
- electrotherapy (e.g. ultrasound)
- taping or bracing
- the use of a protective boot or brace
- the use of crutches
- exercises to improve strength, flexibility and balance
- activity modification
- a graduated return to activity plan
- footwear advice
Despite appropriate rehabilitation management, some patients with a talus fracture do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, periods of plaster cast immobilization, arthroscopic exploration or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured talus. Occasionally, patients with fractures that are initially managed without surgical intervention may require surgery to promote healing and stabilize the fracture. This may involve internal fixation, arthroscopic removal of loose fragments, bone drilling or use of a bone graft to aid fracture healing.