Talus Fracture of the Ankle

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A talus fracture can cause swelling and pain. The talus is one of the major bones that form the ankle joint and serves as an important link between the leg and foot.

Injuries to the talus can have a significant effect on the motion of your ankle and foot joints and limit your ability to walk and bear weight.

Talus fractures are most often seen in car and motorcycle crashes, snowboarding accidents, and severe falls.

Talus fractures were almost unheard of 100 years ago. The first ones were described in British Royal Air Force pilots in the early 1900s. The term "aviators astragalus" was used to describe these fractures that happened as old warplanes made crash landings.

What Is a Talus Fracture?

The talus is the bone located at the top of the foot. As one of the major bones in the ankle, it forms the connection between the bones of the leg (tibia and fibula) and the rest of the bones of the foot (tarsal bones).

It's a unique bone, as the talus is over half covered with cartilage that provides cushion and allows bones to move more freely against each other. The talus contributes to motion not only at the ankle joint but also below the ankle at the subtalar joint and in the midfoot at the talonavicular joint.

The most common place for a talus fracture is in the middle of the bone, called the neck. However, fractures are also common on the protrusion on the outer part of the bone, called the lateral process.

Talus fractures are classified by how much the pieces of bone move from their normal (anatomical) position:

  • Minimally displaced or stable fractures mean the bone is still in or close to its normal position.
  • A displaced fracture indicates that the bone has moved out of its anatomical position.
  • Open or compound fractures are when the bone breaks through the skin.

Talus Fracture Symptoms

Talus fracture causes significant ankle pain, difficulty bearing weight on the ankle, and swelling around the ankle joint. These symptoms warrant going to the healthcare provider right away.

Symptoms of a talus fracture
Verywell / Alexandra Gordon

The most common symptoms of talus fractures include:

  • Pain with movement of the ankle
  • Inability to place weight or walk on the joint
  • Swelling
  • Bruising
  • Tenderness

Causes of Talus Fracture

The talus is a very compact and hard bone. It takes a lot of energy for the talus to break. Talus fractures are seen in high-energy events like a car crash or a fall from a significant height. However, sporting injuries can also cause talus fractures. Snowboarding, for example, is a common cause of lateral process fractures.

Diagnosing a Talus Fracture

You'll most likely visit an urgent care center or emergency room if you're experiencing talus fracture symptoms. Your healthcare provider will perform a physical examination by checking your symptoms and reviewing your medical history. The provider may look for or inspect the following things during the exam:

  • Cuts from the injury
  • Movement of toes and abnormal sensation in the bottom of your foot
  • Your pulse at certain places in your foot
  • A buildup of fluid in your leg muscles, which can indicate a condition called compartment syndrome involving loss of sensation and function
  • Other injuries in the rest of your foot and your body

Imaging tests help your healthcare provider determine what type of injury it is and whether you need surgery. You will likely need an X-ray and, if necessary, a computerized tomography (CT) scan. The X-ray shows if and where the bone is broken, whether anything is out of place, and how many bone pieces there are. A CT scan reveals more detailed information about how severe the fracture is.

Treating a Talus Fracture

Treatment of a talus fracture depends on the extent of the injury. Talus fractures tend to be very painful. As first-aid, you'll want to keep your foot and ankle from moving, such as by using a splint. You'll also need to keep pressure off your ankle.

If the fracture is not out of position, you may not need surgery. A cast or a splint may be sufficient for treatment in these cases.

If the fracture is out of position, then surgery may be recommended to realign the broken bones and stabilize them with screws or pins. Your healthcare provider or surgeon will talk to you about the best way to treat the fracture and realign the bones.

If there is significant swelling, an external fixator may be used to keep the bones in place while the swelling goes down. In rare cases, the bone can be so badly broken that fusion surgery is necessary.

Rehabilitation

Your healthcare provider will tell you how long you need to wear the cast or splint to allow your bones to heal. You may have to be in a cast or a splint for two to eight weeks.

You'll be advised to keep weight off your foot because putting too much weight on your foot before the bones heal can complicate healing, causing the fracture to move.

You may be asked to go back in for X-rays during post-operative care. The X-rays will show how well your bones are healing.

Talus Fracture Complications

Explained in more detail below, three major complications commonly occur with talus fractures:

  • Ankle arthritis
  • Malunion
  • Osteonecrosis

Other potential problems include infection, nonunion, foot deformity, and chronic pain.

Ankle Arthritis

Ankle arthritis is common after a talus fracture because when the cartilage is injured, the normally smooth joint surface becomes uneven. These irregularities can lead to accelerated wear in the joint, and ultimately to arthritis.

Because so much of the bone is covered with cartilage, arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint.

Even with surgical treatment of a talus fracture, the development of arthritis is common. If severe, ankle arthritis may require further treatment.

Malunion

Malunion means that the break has healed, but the position where the bone healed is not anatomically correct.

This abnormal position of the bone can lead to a number of different problems, especially with foot fractures where altered alignment can lead to long-term problems and difficulty walking. Malunions are rare, however.

Osteonecrosis

Osteonecrosis, or avascular necrosis, is a problem that is found commonly in the talus. Injury to the talus can interrupt the supply of blood to the bone. Sometimes the blood supply returns on its own, but when it doesn't, the bone cells die. This condition leads to a slow and painful collapse of the bone.

The more severe the fracture, the more likely osteonecrosis is to occur. Even with surgery to realign the bone and hold the fragments in position, damaged blood supply may lead to this problematic complication.

Recovery From Talus Fracture

The recovery from a talus fracture can be lengthy because until the bone is healed, you cannot place weight on your foot.

Therefore, most talus fractures require a minimum of six to 12 weeks of protection from weight-bearing. In more significant injuries, the time may be longer.

It's very important to properly care for a talus fracture and give yourself time to heal. Some people have ankle pain, stiffness, and swelling that continue even after the bone heals. With enough time, however, these symptoms can improve.

During or after the healing process, your healthcare provider may start you on a rehab program of physical therapy to regain: 

  • Range of motion
  • Stability
  • Strength

You may have to use a cane or wear a special boot and may not be able to put your full weight on your foot for two to three months.

Periodic X-rays

Only time will tell if you'll develop arthritis or osteonecrosis, so your healthcare provider will likely get periodic X-rays to determine the health of the bone and how it's healing.

Summary

A talus fracture is a painful break of one of the major bones of the ankle. It can cause significant swelling and bruising. Common causes include motor vehicle collisions, falls from a significant height, and sports injuries. Get checked out by a healthcare provider if you think you have a talus fracture.

Treatment may be as simple as a cast or a splint, or it may involve surgery. Either way, you'll want to keep your weight off the injured ankle at first. Gradually you'll be able to add more and more weight as the bone heals. The healing process can take a while. Be gentle with yourself during recovery and give your bones time to heal.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.