Breaking of the ankle bone (talus) is medically termed as Talus Fracture. The talus connects the leg bone to the foot and lies just above the calcaneus. The subtalar joint formed by talus and the heel bone enables us to walk as well as maintain balance on uneven surfaces. The joint is lined by protective articular cartilage which prevents the bones from rubbing against each other. Talus fracture may occur either in the middle or outer portion of the bone. Such fractures are generally serious and can lead to considerable damage to the joint. If not treated timely, it may eventually lead to complications such as Compartment Syndrome, Post Traumatic Arthritis and Avascular Necrosis.
Causes
- Automobile accident
- Falling from a height and landing on the feet
- Forceful outward pushing of the ankle
- Sports injuries
The talus is a strong and very protected bone. It is rare for a talus to fracture, but high amounts of energy that could be experienced in a fall from a great height or a car wreck will do it. A fracture of the talus is both serious and painful. Immediately a large amount of the range of motion of the foot will be lost, and without surgical intervention many talus fractures will result in a severe limp, arthritis and severe chronic pain.
Symptoms
- Inability to bear body weight while standing
- Swelling
- Bruising
- Severe pain
- Fractured bone may be seen protruding out of the skin
- The joint may feel tender when touched
Diagnosis
- Clinical examination of the injured foot
- The nerve conduction ability and blood supply to different parts of the foot and leg may be checked
- X-ray imaging may help to determine the location and severity of fracture. It may also reveal the severity of the fracture or any dislocation of the bone
- CT scan may help to detect damage to soft tissues and minute cracks in the bone
Treatment
The methods of treatment may include one or more of the following.
- The foot may be put in a soft padded splint to keep it stable
- The foot needs to be rested while keeping it elevated at chest level
- Stable fractures with minimal displacement may be treated non-surgically by placing the foot in a cast to avoid putting any pressure on the joint
- Immobilization may be followed by physical therapy to restore movement, flexibility and strength of the joint as well as the adjoining muscles
- Medicines may be prescribed to combat pain and inflammation
- In case of multiple breaks in the bone or greater degree of displacement, surgery may be required. The procedure may involve realigning the bone parts to their actual position.
- Metal screws and wires may be used to fix the bone to its position.
- Use of a walking stick or cane may be recommended post surgery
- Specially designed boots to lift pressure from the talus can be worn for some time
While many talus fractures require surgical treatment due to the high-energy nature of their origin causing displacement that would be detrimental to body mechanics of the foot, some fall into the scope of non-operative treatment if they are stable and relatively non-displaced. For talus fractures that are treatable by casting, the patient will be non-weight-bearing in a cast for six to eight weeks, and then followed up on with physical therapy to work on recovering flexibility, strength and range of motion.
Surgical intervention is usually necessary and will require an open reduction, to realign the natural place of the bone, and then stabilization. The stabilization will be completed with the addition of hardware, such as metal plates and screws. After a fracture, arthritis may set in and eventually require a fusion such as a subtalar fusion.
Talus Fracture and Avascular Necrosis (AVN)
Unfortunately, one of the common side effects of a talus fracture is eventual bone death of the talus from avascular necrosis (AVN). Avascular necrosis, or AVN, is a condition in which blood supply is no longer delivering sufficient oxygen to the bone. Avascular necrosis can occur throughout many areas in the body such as the knee or hip as well. When avascular necrosis is present in the talus, damage is sustained to surrounding cartilage as well. This condition is hard to treat and can result in severe arthritis, pain and loss of stability of the ankle joint. If you fracture your talus, it is important to follow up with a physician throughout the healing process so that if you have AVN set in you can be treated as soon as possible.
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