Physical Therapy Videos - Foot & Ankle
Basic Anatomy
The talus is a bone in your foot that forms part of the ankle joint. It sits between your shin bone (tibia), and your heel bone (calcaneus). The joint between the talus and the calcaneus is called the subtalar joint. This joint allows for side to side motion of the foot and helps us when we walk on uneven ground. The blood supply to the talus comes from several small arteries. Fractures of the bone often damage the blood supply to the bone and can affect healing. The talus is kept in place by strong ligaments (which connect bone to bone). The ligaments can also be injured and cause the talus to become unstable in the ankle joint.
Mechanism and Epidemiology
The talus is a strong bone since it bears the entire body weight. To break the talus bone, it usually takes a lot of energy such as falling off of a ladder, a roof, or from a car accident. The most common area the talus fractures is in the mid portion in an area called the neck. The neck is located between the "body" of the talus, which is by the ankle joint, and the "head" of the talus, which is by the foot.
Another common place for the talus to break is on the outside part of the bone called the "lateral process," which can happen when the foot is forced in an outward direction. This is sometimes called a "snowboarder fracture" because it often occurs when snowboarding.
In more severe injuries, the talus can break and dislocate (come out of the joint), either at the ankle joint, the subtalar joint, or both. When this happens, it is important for a physician to put the bones and joints back in place as quickly as possible.
General Treatment
Talus fractures are typically very painful. The first step in treatment is to place you in a splint to keep the foot and ankle from moving, which can help with the pain. You may also need a CT scan of the bone. The CT scan will help your surgeon to decide if surgery is needed and to see if any other bones in the foot are broken. 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. Plates and screws are used to hold them in place. This type of procedure is called "open reduction internal fixation." Surgery is usually done by making two cuts—one on the inside part of the foot and the other on the outside part of the foot. Your surgeon will determine how to best approach the fracture and realign the bones.
Sometimes, there is too much swelling around the foot and ankle to make cuts in the skin. If this is the case, it can be difficult to heal the wounds. In this case, your surgeon may choose to keep you in a splint until the swelling goes down. You may be placed in an external fixator to hold the bones in place. This also helps take the pressure off of the skin and other soft tissues. With an external fixator, large pins are inserted into certain bones of your foot and ankle. These pins are visible outside of your skin, with special bars used to connect the pins to each other. This is usually temporary for a couple of weeks until the swelling goes down.
In rare cases, some or all of the talus might be missing or broken so badly it will not heal. If that happens, your surgeon may fuse the remaining bone with screws, long rods (nails), or plates and screws.
Post-operative Care
After surgery, you will be placed into a splint or a cast. This is to keep your foot still and allow your bones and soft tissues to heal. Whether you had surgery or not, you will usually not be allowed to put any weight on your foot. If you put too much weight on your foot before the bones heal, the fracture may move. Once the bone heals, you can gradually increase the amount of weight you put on your foot according to your surgeon’s recommendations. This usually takes 8 to 12 weeks. As you heal, the doctors will take more x-rays to monitor how your bones are healing. Your surgeon will also keep a close eye on your incisions to make sure they are healing properly.
Long Term
Talus fractures are a difficult injury. Some people experience continued pain, stiffness, and swelling even after their bones heal. This often improves over time, but you may always notice a difference compared to your other side.
Because talus fractures often occur in high-energy situations such as falls from height, an injury to the cartilage often occurs. When this happens, you may eventually develop arthritis in the joint. If your symptoms become so severe, additional procedures, such as a joint fusion or ankle replacement, might be done.
Over time, your surgeon will likely want more x-rays, not only to check the alignment of the fracture, but also at the quality of the bone. Because the blood supply to the bone is delicate, it can easily be disrupted by the fracture. If there is no blood supply to the bone, the bone cells may die. This is called avascular necrosis, and it is a common complication after a talus fracture. If this happens more surgery may be needed.
Physical Therapy Videos - Foot & Ankle
More Information
---
Ashlee MacDonald, MD and Gillian Soles, MD
Edited by the OTA Patient Education Committee
X rays and images from the personal collection of Dr. MacDonald, Dr. Soles and Christopher Domes, MD