A talus fracture is a broken ankle bone. The talus is the bone in the back of the foot that connects the leg and the foot. It joins with the two leg bones (tibia and fibula) to form the ankle joint and allows for upward and downward motion of the ankle. The talus (ankle bone) sits within the ankle mortise or hinge, which is made up of the two leg bones, the tibia and fibula. There are three joints:
- the ankle, which allows the up-and-down motion of the foot with the leg
- the subtalar joint, which allows for side-to-side movement
- the talonavicular joint, which has a complicated biomechanical function that controls flexibility of the foot and the arch of the foot.
The talus has no muscular attachments and is mostly covered with cartilage, which makes injuries difficult to heal.
Most patients present with pain and swelling around the ankle. They also experience severe ankle pain and difficulty walking due to bruising and swelling.
Ankle fractures often are the result of high-energy injuries. Falls from ladders and automobile accidents result in the most severe injuries. However, these fractures also may occur from twisting the ankle, which can result in small chips or fragments that are broken off the edges of the ankle.
In many cases the diagnosis can be made by your physician on physical examination alone. He or she will examine your foot for evidence of swelling or bruising around the ankle. X-rays help visualize the extent of joint involvement and show the location and size of bone fragments. Oftentimes a CT scan is ordered to provide the physician with more information about the fracture. Due to the high energy that is commonly associated with these injuries, your physician also may examine you for other injuries involving the back, neck, head and other extremities.
Talus fractures may be treated in a cast or surgery may be recommended.
Non-surgical treatment is recommended for fractures in which the pieces of bones remain close together and the joint surfaces are well-aligned. Patients who smoke or have diabetes or poor circulation may be treated without surgery due to the very high risk of developing complications if surgery is performed.
For a majority of patients, surgical treatment is the correct form of treatment. The goal of surgery is to restore the size and shape of the talus. Sometimes this is a problem as the multiple fragments of bone are like putting together the pieces of a difficult puzzle. If the bone has several large pieces, your foot and ankle orthopedic surgeon may perform open reduction and internal fixation (ORIF). The procedure involves making a cut(s) on your foot and placing a metal plate and/or screws to hold the bones together until healing occurs. The procedure aids in restoring the function of your foot.
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. You should expect some swelling around the foot for several months after the procedure.
This injury can be very debilitating with persistent pain, stiffness and swelling even after an excellent non-surgical or surgical treatment. However, most people, depending on the type and severity of the fracture, are able to return to most work and recreational activities.
Risks and Complications
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. People who smoke, diabetics, and those with poor circulation are at greatest risk for these complications.
Late complications typically are related to the severity of the initial injury. Most people experience a certain degree of stiffness within the foot and ankle. When the blood supply to the ankle is damaged it can lead to death of the bone, a condition called avascular necrosis (AVN). This condition can lead to significant deformity and arthritis and require additional surgery.
How long will I be out of work?
This is a severe injury. Depending on the type of work performed, most people are unable to return to work for at least two weeks after the injury. Those with active jobs may not be able to return for six months to a year.
Do the plates and screws need to be removed?
Plates and screws hold the bones together so that they can heal. Once the bones are healed the hardware serves no purpose. However, most orthopedic surgeons do not recommend removal of the plate and screws unless there are problems with pain or infection.