Talus is the medical term for the talus bone. The talus is a tarsal bone. The tarsus connects the lower leg to the foot and toes via the ankle joint. The talus plays a crucial role here and is decisive for foot statics. Due to its central position in the ankle joint, the talus absorbs the force of the body weight and transfers it to the foot. When walking, running and jumping, significantly greater forces act on the foot. The bone can only withstand this load because it is denser and more stable than others.
The talus bone in conjunction with the foot bones. © bilderzwerg / Fotolia
This makes it clear that talus fractures (ICD code: S92.1) can have considerable consequences. Compared to other foot fractures, for example metatarsal or toe fractures, where it is still possible to walk, this is definitely no longer possible with talus fractures. This is simply due to the central position of the talus in the foot and the main load placed on it. No other tarsal bone is subjected to as much stress as the talus.
Not all areas of the talus are affected by fractures with the same frequency. Most talus fractures occur at the neck of the bone. Fractures of the body of the talus, on the other hand, are rare and are usually caused by external force, such as accidents or falls from a great height. A typical accident mechanism would be a jump or fall from a great height, for example when hiking, climbing or for professional reasons when working on a roof or scaffolding. Fractures to the outer parts of the talus also occur. They are almost always caused by twisting an ankle.
A fracture of the talus is often accompanied by concomitant injuries which, unlike open wounds, are not always recognizable at first glance. These include foot dislocations and distortions (dislocation and sprain of the ankle joint), a broken lower leg and fractures of the metatarsus or tarsus(foot fractures). This means that a misalignment of the foot or lower leg can be the first indication of a talus fracture.
Other important symptoms are pronounced pain and swelling, which can be felt and seen.
The rapid onset of swelling is a typical sign of a bone fracture. Bruising also occurs at the fracture site. In addition to the swelling, there may also be a circulatory disorder in the foot or pronounced sensory disturbances, which must always be checked during the physical examination. Joint instability, i.e. a loss of joint strength with unusual mobility, is also a strong indication of a fracture.
The talus fracture is associated with severe pain. The physical examination reveals very severe pressure pain over the middle foot, over the ankle joint and especially over the fractured talus. Pain-free walking is no longer possible. Sometimes the fracture is accompanied by an open injury, so there is a risk of infection.
© Leo / Fotolia
Talus fractures can potentially lead to significant complications. One of these is the death of bone cells as a result of reduced blood flow. Neighboring bones such as the heel bone can also be fractured. In the case of fractures, the skin over the body of the talus is overstretched to such an extent that skin cells can die off. Only X-rays or computer tomography(CT) can provide information about the exact clinical picture.
As the talus plays such a central role in the anatomy of the foot, incorrect treatment or premature reloading can be dangerous and can lead to a permanent reduction in walking ability or even loss of the leg. Early trauma surgery treatment and therapy is therefore essential.
Simple, smooth fractures without splinters can be treated conservatively, without surgery. Whether with or without surgery, the foot and lower leg must always be consistently immobilized and splinted. Once the swelling has subsided, a recumbent cast and later a walking cast can be applied.
Until then, you must not walk. Thrombosis injections are essential as long as mobility is restricted, i.e. weight bearing is not permitted. The lack of weight-bearing can cause the blood to pool in the veins and lead to thrombosis. This potentially leads to further swelling, which can exacerbate the disease process. Thrombosis-related complications can also occur, such as clots being carried to the lungs.
This is another reason why the leg should be elevated as often as possible during the recovery period. This not only reduces the swelling, but also reduces the risk of developing a thrombosis.
© sunnychicka / Fotolia
Experience shows that many patients have permanent problems after talus fractures. In particular, talus fractures that are treated without surgery lead to problems more frequently than those that are surgically stabilized by trauma surgery. Consequently, it can be said that very few talus fractures heal without surgery.
Screws and wires are used to surgically align the bone. In most cases, partial weight-bearing with a maximum weight of 15 kg is permitted after just a few days. Depending on the fracture, full weight bearing is possible after 6-8 weeks. Crutches are an important aid to ensure this reduced load on the ankle joint.
To prevent long-term damage, the patient should start physiotherapy after the first week. This targeted muscle strengthening increases the mobility of the ankle and promotes healing. It also significantly reduces the risk of developing a thrombosis of the leg veins and, from a certain level of activity, a thrombosis injection is no longer necessary.
Sport is permitted after three months at the earliest, preferably after six months. As the talus is a very sensitive part of the body, patients should be careful and follow the doctor's medical and physiotherapy instructions exactly.
The prognosis depends on the type of fracture, the extent of soft tissue damage and the type of surgery. Patients need a lot of patience after talus surgery, as they are not allowed to put full weight on their foot for at least six weeks.
Post-traumatic arthrosis is a common complication. This leads to signs of wear and tear in the joint and is therefore particularly likely in the case of fractures involving the joint.
In order to prevent long-term consequences, rehabilitation measures are indicated. What this looks like depends on the findings and the responsible health insurance company. In most cases, three-week rehabilitation cures in specialized facilities are prescribed. Whether pain-free walking is possible again afterwards is also influenced by the patient's cooperation and individual requirements such as age, athleticism and weight.
Nevertheless, patience and optimism are the best prerequisites for being able to lead a carefree professional, sporting and private life again once a talus fracture has healed.
