Stress Fractures of Talus

The talus or anklebone is one of a group of small bones that form the hind part of the foot called the tarsus. The talus is the second largest tarsal bone and forms the lower part of the ankle joint. At its upper surface it articulates with the bones of the lower leg and is therefore responsible for transferring the whole load of the body to the foot. Below it joins the heel bone, while in front it articulates with the other tarsal bones. Therefore, the tarsus has a very important anatomical location; it not only transfers the load but also is involved in upward, downward and sideways movement at the ankle joint.

Cause:

Stress fractures of bones result from excessive loads repeatedly being placed on the bone. These involve weight-bearing bones of the body such as those of the leg and foot and present as a small crack (also known as hairline fractures). These are quite common in athletes and dancers, accounting for up to 10% of sports related injuries.

Stress fractures may also occur at normal activity levels if the bone quality is poor as a result of osteoporosis or other diseases that weaken the bones. These fractures are sometimes referred to as “insufficiency fractures”.

Stress fractures of the talus are uncommon and mostly result from excessive running, a sudden increase in exercise intensity or high impact sports involving running and jumping such as soccer, basketball, athletics etc. Faulty foot biomechanics such as over pronation (excessive inward rolling of the foot) may increase the risk. Wearing ill-fitting shoes, inadequate warm-up, weak muscles or joint problems all increase the risk of stress fractures.

Symptoms:

• There is mild deep-set pain in the ankle.
• The pain gets worse with activity, such as running or sprinting.
• If not cared for pain may persist, even at rest.
• Pain may be elicited by pressing on the talus.
• Swelling may also be present.

Diagnosis:

The patient’s medical history and physical examination give a clear indication of the problem. A CT scan or MRI may be recommended for confirmation.

Treatment:

Talus fractures are slow to heal because the talus lacks good circulation. Complete healing may take several months. The first phase involves relieving the bone of any kind of stress. This is achieved by complete rest and cessation of any activity that causes pain.

A plaster cast may also be applied for about six weeks, depending on the case. After the cast is removed, the bone is gradually subjected to loads over a period of several weeks to months.

Massage, electrotherapy, hydrotherapy, or strengthening exercises to improve flexibility and strengthen the ankle joint all help.

Stress fractures of the talus respond well to conservative therapy; however, surgery may often be required to pin the fractured bone for better stability and rapid healing. Lateral process of the talus may also be removed.

Insole devices are required to correct any biomechanical faults, to aid in healing and prevent further deterioration.

Stress fractures can be prevented by subjecting the bone to moderate stress in a controlled fashion. This makes the bone stronger and better able to withstand increasing loads and repetitive stresses. Strengthening exercises for the leg muscles also help to improve stability and correct any postural defects.