Talus Fracture

What is a talus fracture?

Your talus is a bone in your foot that connects your ankle to your leg. A talus fracture is a break in this bone. Your talus joins with your tibia and fibula (lower leg bones) to form your ankle joint. This joint allows for the up and down movement of your foot. Your talus sits above your heel bone (calcaneus), forming your subtalar joint. This joint allows for the side-to-side movement of your foot.

Your talus helps transfer weight across your ankle joint. It’s mostly covered in cartilage. Cartilage is a slippery material that allows your bones to move smoothly against each other. A talus fracture can cause a significant loss of motion and function because of how important it is for ankle movement.

What are the different types of talus fractures?

Your talus bone can break in different places and different ways. Talus bone fractures include:

• Neck. The most common type of talar fracture occurs in the mid-section of your talus. This is called the neck. The neck is between the “body” of your talus, which is under your tibia by your ankle joint, and the “head” of your talus, which is farther down your foot.
• Lateral process. The outside of your talus bone is called the lateral process. These types of fractures occur when your ankle is forced outward to the side. Lateral process talus fractures are commonly seen in snowboarders and are sometimes called “snowboarder fractures.”
• Avulsion fractures. A talar avulsion fracture occurs when a small part of your talus bone pulls away from the rest of the bone where it’s attached to a ligament or tendon.
• Stress fractures. A talar stress fracture is a small crack in your talus bone. This type of fracture happens because of overuse or repeated stress put on your talus bone.

How are talus fractures classified?

Talus fractures are classified by how much the talus or pieces of bone have moved out of their normal position. These classifications include:

• Minimally displaced or stable. The talus bone is only slightly out of place and the broken ends of your bones still line up correctly or almost correctly.
• Displaced. The talus bone breaks and the pieces move out of their normal position.
• Open or compound. The talus bone breaks through your skin. The surrounding muscles, tendons and ligaments may be affected as well.

What are the symptoms of a talus fracture?

The most common symptoms of a talus fracture include severe ankle pain and swelling. Other symptoms may include:

• Difficulty walking.
• Inability to place weight on your foot.
• Bruising.
• Tenderness.
• Fracture blisters (fluid-filled blisters on your skin).

How do talus fractures happen?

Talus fractures most commonly occur due to high-energy injuries. These injuries include car and motorcycle accidents and falls from significant heights. Talus fractures occur due to sports injuries, too. Many snowboarders break their talus bones. Sometimes, talus fractures occur due to twisting your ankle, which can result in small chips breaking off the edges of your talus.

How is a talus fracture diagnosed?

Your healthcare provider will examine your ankle and foot, looking for swelling, bruises and cuts. They may:

• Ask you to move your toes, checking for nerve damage.
• Check the pulses in your foot, to ensure a good blood supply.
• Make sure fluid isn’t building up in the muscles of your leg. This is called compartment syndrome, which can result in a loss of feeling and function in your leg.
• Examine you for other injuries, depending on the cause of your injury.

Your healthcare provider may also request the following imaging tests:

• X-ray. An X-ray can show if your talus is broken, if the bone fragments are in place and how many bone fragments there are.
• Computed tomography (CT) scan. A CT scan can show the severity of your injury by producing a cross-sectional image of your foot.

What is the treatment for a talus fracture?

Treatment for a talus fracture depends on the type of fracture and the severity of your injury. First, you’ll be placed in a splint to keep your foot and ankle from moving. If your fracture is stable and your joints are well-aligned, surgery may not be necessary. Your healthcare provider may recommend:

• Casting. A cast holds together the bones in your foot and ankle while they heal. Typically, you’ll have to wear the cast for six to eight weeks and put minimal pressure on your foot.
• Rehabilitation. After the cast is removed, you’ll be given exercises to help restore the strength and function of your foot and ankle.

For most talus fractures, ankle surgery will be recommended because of the high-energy force that caused the injury. If your bones are out of place, a foot and ankle surgeon will perform surgery to reset them.

If your bone is broken into several pieces, your surgeon may perform an open reduction and internal fixation (ORIF). With an ORIF, your bone fragments are put back in place and held together with a metal plate and/or screws until your bone heals.

If there’s too much swelling, your surgeon may place you in an external fixator. With an external fixator, your surgeon will place large pins in your bones to hold them in place. The pins are visible from the outside of your skin and are held together with special bars. After the swelling goes down, your surgeon may try an ORIF again.

What are the complications of an untreated talus fracture or a talus fracture that doesn’t heal properly?

A talus fracture can cause difficult complications if left untreated or if it doesn’t heal correctly. These complications include:

• Posttraumatic arthritis. Your talus bone is covered in cartilage. When you injure your talus, you also injure the cartilage around it. When your cartilage becomes uneven, it can lead to wear and tear in the joint. This can cause arthritis.
• Malunion. A malunion means the fractured bone healed in an abnormal position. A malunion can lead to long-term problems like difficulty walking.
• Nonunion. A nonunion means the fractured bone didn’t heal after an extended period of time.
• Avascular necrosis or osteonecrosis. Blood supply to your talus bone can be interrupted because of a fracture. Without the correct blood supply, your bone cells die. This can lead to the collapse of your bone.

What can I expect of the recovery process with a talus fracture?

After surgery, you’ll experience some pain. Your healthcare provider can prescribe a medication to help with the pain. These medications may include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) or local anesthetics.

Once your talus bone is healed, your healthcare provider may recommend rehabilitation or physical therapy to help improve the function of your ankle. Exercises can help with your range of motion, stability and strength in your foot and ankle.

When you start walking again, you may have to wear a special boot or use a cane. You won’t be able to put full weight on your foot for a few months.

Your healthcare provider will want to take X-rays to make sure the bone has healed properly, too.

What is the long-term prognosis for a talus fracture?

With or without surgery, your foot will be in a cast or splint. You won’t be able to put any weight on it or walk on it. Depending on the complexity of your injury, you may have to wear the cast for eight to 12 weeks or more.

The more severe your injury, the longer your foot will be in a cast. You may have persistent pain, stiffness and swelling even after the bone heals. After treatment, many people may return to normal activities after your healthcare provider gives you clearance to do so.

When can I go back to work?

Depending on the severity of your injury and the type of job you have, you may not be able to return to work right away. Most people don’t return to work for at least two weeks. If you’re on your feet all day, you may not be able to return to work for up to a year.

Can you walk on a talus fracture?

It depends on the type of talus fracture you have. A talus fracture can be a severe injury. A talus fracture can result in a significant loss of motion and function of your ankle and foot joints. This can affect your ability to walk and bear weight on your foot.

How long does it take for a talus fracture to heal?

Depending on the complexity of your injury, you may have to wear a cast for three months or more. You may have pain, swelling and stiffness even after the cast is removed.

What does a talus fracture feel like?

A talus fracture is a high-impact injury. People describe talus fractures as extremely painful.

How do you fix a broken talus?

Some talus fractures can be corrected by casting and rehabilitation. However, most talus fractures require surgery to correct the alignment of your bones.

A note from Cleveland Clinic

A talus fracture is a painful injury usually caused by a high-impact accident such as a car accident or fall. If you have a talus fracture, you’ll want to be seen by your healthcare provider right away. Talus fractures usually require surgery to repair. You’ll be in a cast for a minimum of two weeks (for a simple fracture) and up to 12 weeks or more depending on the severity of your injury. While a talus fracture can cause pain, treatment will help with the healing process, and you’ll be back to normal activity as soon as possible.