Your talus bone is the bottom part of the ankle joint. It connects your foot to the two bones in your lower leg — the tibia and fibula — that make up the top part of the ankle. The talus lies just above the calcaneus or heel bone and below the tibia or shin bone. Together the talus and calcaneus are critical to your ability to walk.
A talus fracture usually results from serious trauma to the foot. Injuries that could cause a talus fracture include a fall from a great height or a car accident. A badly twisted ankle can also cause small pieces of the talus to break off.
If the fracture doesn’t heal properly, you could have walking problems. So many talus fractures require surgery soon after the injury occurs to prevent problems later.
Classifications of talus fractures
Talus fractures are usually classified based on the severity of the injury and how much the bone is moved from its normal position. There are three main classifications:
Minimally displaced (stable) fracture
In this type of break, the bone is moved only slightly out of place. The fractured ends of the bone are still basically lined up properly. The break can usually heal without surgery.
Displaced (unstable) fracture
Any time a bone moves out of its normal position, it’s called a displaced fracture. Highly displaced fractures are considered to be unstable. Surgery is typically required to get the broken parts of the talus to line up correctly again.
This is the most severe type of fracture. If a piece of broken bone pierces the skin, it’s considered an open or compound fracture. Muscles, tendons, ligaments, and nerves may also be injured.
Surgery to treat an open talus fracture often involves much more than lining up the broken pieces of bone. Pins or screws may be needed, as well as treatment of the damaged muscles and other tissue.
The risk of infection is higher with these injuries. The recovery is also much longer.
Other types of talus fractures
In addition to those fractures, you may also break your talus in other ways.
The talus is one of several bones commonly subject to a stress fracture in the foot. A stress fracture is a small crack or a bruise of the bone. It usually happens as a result of repetitive actions putting stress on a bone or joint. In some cases, changing an activity, such running on a harder surface or with more incline than you’re used to, can trigger a stress fracture.
The talus bone can also chip. A small piece of bone can become separated from the rest of the talus. This can happen with a serious sprain. If the chip is discovered early, you may be able to have a cast around your ankle for several weeks while the bone heals. If it doesn’t heal properly, you may need surgery to have the chip removed. The bone may also be drilled into to promote blood vessel growth and healing of the chipped bone.
What are the symptoms?
Your symptoms will vary greatly, depending on the type of talus fracture.
- Minimally displaced. Acute pain in the ankle is usually the first sign. There may be some minor swelling and tenderness. You should be able to walk on it, but not without pain.
- Displaced. The pain, swelling, and tenderness are greater. You may not be able to put weight on the injured ankle.
- Open. The most obvious symptom is the sight of bone sticking through the skin. The pain will be very intense. There could also be considerable bleeding. It’s not uncommon for someone with an open fracture to pass out from the shock or loss of blood.
A stress fracture or chip may feel more like a sprained ankle. You’ll feel pain and tenderness, especially when walking on it. But the pain may not be bad enough to make you think there’s a fracture. This can sometimes lead people to put off getting an exam and treatment, when early treatment could speed up their recovery.
How is this diagnosed?
If your doctor suspects a talus fracture, they’ll carefully examine your ankle, checking for obvious displacement. You may be asked to move your toes and whether you have normal sensation on the bottom of your feet. Your doctor does this to check for nerve damage. They’ll also check to see if the blood supply seems healthy to the foot.
If you were in an accident or you fell, your doctor will also check for damage to your legs, pelvis, and back.
To confirm a fracture and determine its severity, some imaging of the ankle will be necessary. Usually, an X-ray is all that’s needed to determine the extent of the fracture and displacement. An X-ray can also show how many pieces of bone are involved.
Your doctor may order a CT scan if they need to see more detail. This may be necessary with more severe breaks and when there may be more than one fracture line in the talus.
How it’s treated
Immediate treatment of a talus fracture includes immobilizing the foot and elevating it above the heart. An open fracture should be treated as a medical emergency. Less serious injuries may not require an emergency room visit. An evaluation by an orthopedist may be enough.
If the talus fracture is stable, nonsurgical treatment options may be available to you. It’s worth noting that because of the high-force nature of a talus fracture injury, many breaks tend to be unstable, requiring surgery.
Surgical treatment involves setting the broken pieces back in alignment and then using pins, screws, or special plates to keep them together while they heal.
You could be a cast for eight weeks after surgery. Little to no weight should be placed on the ankle during that time, but this will be a decision made by your orthopedic surgeon.
The recovery timeline could be shorter if the surgery appeared to go well and there was relatively little displacement.
One of the first stages of recovery is pain management. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve), may be helpful. If the pain is too great, your doctor may prescribe stronger painkillers. However, these drugs can be addictive, so be careful not to use them for more than a few days. If you feel you need them for a longer period, talk with your doctor.
Physical therapy to improve the strength and flexibility of your ankle should begin once the cast is removed. Slowly, you’ll start to do more weight-bearing exercise, such as walking — perhaps with a cane — and using stairs.
What’s the outlook?
If your talus fracture is treated promptly and effectively, there should be no long-term complications. Two complications can develop, however.
One is post-traumatic arthritis. Damage to the cartilage in the ankle joint can develop into arthritis down the road, even if the talus fracture heals properly. In many cases, it’s minor and more of a nuisance than a problem that interferes with your daily activities. If the arthritis is serious, you may need surgery to treat the cartilage and stabilize the ankle.
The other complication is avascular necrosis. The bone can become damaged when healthy blood flow to the broken bone is disrupted by injury. In serious cases, when the blood vessels don’t recover, bone cells die and the ankle can collapse. In many cases, though, blood flow resumes and the prognosis is a healthy one.
If you get good treatment and you follow your doctor’s advice during your recovery, you should eventually be able to enjoy the activities you once did prior to your injury.