A talus fracture is a break in the talus bone, situated in the ankle joint. The ankle joint comprises three bones: the tibia (larger bone on the inner side of the leg), the fibula (smaller bone on the outer side of the leg), and the talus, located toward the back of the foot. These bones facilitate upward and downward motion of the ankle.

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The talus rests atop the heel bone (calcaneus) and lies just behind another foot bone called the navicular. The joints formed by the talus, calcaneus, and navicular bones enable side-to-side movement of the foot and contribute to the foot's arch.

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Due to its lack of muscular attachments and predominance of cartilage covering, injuries to the talus bone are challenging to heal.

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Symptoms

Most individuals with a talus fracture experience pain and swelling around the ankle. Severe ankle pain and difficulty walking are common due to bruising and swelling.

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Causes

Talus fractures often result from significant force applied to the ankle. Falls from heights, such as ladders or automobile accidents, can cause severe injuries. Twisting the ankle can also lead to small chips or fragments breaking off the ankle's edges.

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Diagnosis

Dr. Kamel can often diagnose a talus fracture through a physical examination alone. He will assess the foot for swelling or bruising around the ankle and may request X-rays to evaluate the joint involvement and identify bone fragments. A CT scan may provide additional information about the fracture's extent. Due to the high energy associated with these injuries, the physician may also check for injuries to other body parts.

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Treatment

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Non-surgical Treatment

Fractures where bone pieces remain close together and joint surfaces are well-aligned may be treated without surgery. However, individuals using nicotine or with diabetes or poor circulation may be treated without surgery due to the high risk of complications.

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Surgical Treatment

For most patients, surgical treatment is recommended. Surgery aims to restore the talus's size and shape, often challenging due to multiple bone fragments resembling a difficult puzzle. In cases with several large bone pieces, open reduction and internal fixation (ORIF) may be performed. This involves making incisions on the foot and using metal plates and/or screws to hold the bones together until healing occurs.

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Recovery

Recovery can be prolonged, with no weight-bearing or walking on the leg allowed for 6-12 weeks. Following bone healing, exercise and physical therapy can improve ankle function, including strength, range of motion, and stability. Swelling around the foot may persist for several months post-procedure. Although persistent pain, stiffness, and swelling can occur even after successful treatment, most individuals can return to most work and recreational activities depending on the fracture's type and severity.

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Risks and Complications

Talus fractures can lead to long standing foot and ankle problems, with early complications often related to significant post-injury swelling, leading to wound problems and infection. Late complications may result from initial injury severity, such as stiffness, avascular necrosis (bone death due to blood supply damage), significant deformity, and arthritis.