A talus fracture is a broken bone in your ankle. The ankle joint is made up of three bones: the tibia (the larger leg bone toward the inside), the fibula (the smaller leg bone on the outside), and a bone toward the back of the foot called the talus. These three bones allow for upward and downward motion of the ankle.
The talus sits on top of the heel bone (calcaneus) and just behind a bone in the foot called the navicular. The joints formed by the talus, the calcaneus, and the navicular bones allow the foot to move side-to-side and help to create the arch of the foot.
Because the talus has no muscular attachments and is mostly covered with cartilage, injuries to this bone are difficult to heal.
Most patients with a talus fracture have pain and swelling around the ankle. They also experience severe ankle pain and difficulty walking due to bruising and swelling.
Talus fractures often occur from high levels of force on the ankle. Falls from ladders and automobile accidents result in the most severe injuries. However, talus fractures also may occur from twisting the ankle, which can result in small chips or fragments
that are broken off the edges of the ankle.
In many cases your foot and ankle orthopaedic surgeon can diagnose a talus fracture with a physical examination alone. He or she will examine your foot for evidence of swelling or bruising around the ankle. They will get X-rays to see the extent of the joint involvement and show the location and size
of bone fragments. Oftentimes a CT scan is ordered to provide the physician with more information about the fracture. Due to the high energy/force that is commonly associated with these injuries, your physician also may examine you for other injuries
involving the back, neck, head, and other extremities.
Depending on the extent of the injury, your surgeon may recommend treating your talus fracture with immobilization (in a cast or boot) or surgery.
Non-surgical Treatment
Non-surgical treatment is recommended for fractures in which the pieces of bones remain close together and the joint surfaces are well-aligned. Patients who use nicotine or have diabetes or poor circulation
may be treated without surgery due to the very high risk of developing complications if surgery is performed.
Surgical Treatment
For a majority of patients, surgical treatment is the recommended form of treatment. The goal of surgery is to restore the size and shape of the talus. Sometimes this is challenging as the multiple fragments of bone are like putting together the pieces of a difficult puzzle.
If the bone has several large pieces, your foot and ankle orthopaedic surgeon may perform open reduction and internal fixation (ORIF). The procedure involves making a cut(s) on your foot and placing a metal plate and/or screws to hold the bones together until healing occurs. The procedure aids in restoring the function of your foot.
X-ray images of a talus fracture before surgery (above) and after surgery (below). For this patient, the surgeon used two screws to repair the fracture.
Recovery can be prolonged. No weight or walking on the leg will be allowed for 6-12 weeks. Once the bone is healed, you will start exercise and physical therapy to improve the function of your ankle (e.g., strength, range of motion, stability). You should expect some swelling around the foot for several months after the procedure.
This injury can be very debilitating with persistent pain, stiffness, and swelling even after an excellent non-surgical or surgical treatment. However, most people, depending on the type and severity of the fracture, are able to return to most work and
recreational activities.
Talus fractures are quite severe injuries and can lead to longstanding problems with the foot and ankle. There are early and late complications.
Early complications most often are related to the significant swelling that can occur after these injuries, which can cause wound problems and infection. People who use nicotine, have diabetes, or have poor circulation are at greatest risk for these complications.
Late complications typically are related to the severity of the initial injury. Most people experience a certain degree of stiffness within the foot and ankle. When the blood supply to the ankle bone is damaged it can lead to death of the bone, a condition called avascular necrosis (AVN). This condition can lead to significant deformity and arthritis and require additional surgery.
Time off work after talus fracture surgery depends on the severity of your injury and the type of work you perform. For sedentary work, most people can return to work several weeks after the surgery. Those with active jobs may not be able to return for six months to a year.
Plates and screws hold the bones together so that they can heal. Once the bones are healed the hardware serves no purpose. However, most orthopaedic surgeons do not recommend removal
of the plate and screws unless there are problems with pain or infection.
No. If the hardware sets off the detection systems at the airport, you will receive further screening by TSA.
Contributors/Reviewers: Sudheer Reddy, MD; Jeffrey Feinblatt, MD
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.
