What is the Talus?
The talus sits in the middle of the ankle bone and connects with the ankle joint above, the subtalar joint below, and the mid-foot joint in front. It has a head, neck, and body. Generally, the bone is subjected to high-force weight-bearing activities, including walking and running, increasing the risk of bone stress.
Stress Fracture in Talus
A stress fracture is a small crack within a bone caused by repetitive strain or overuse. In the talus, stress fractures often occur in the neck or body, which bear substantial loads during activities like running or jumping. Sometimes, bone stress is seen in the body of the talus.
Generally, these stress fractures are rare, occurring less commonly than navicular or calcaneal stress fractures.
Symptoms of Talus Stress Fracture
Symptoms of a talar stress fracture can develop suddenly or gradually and may include:
- Persistent pain at the front of the ankle, which worsens with activity. As the condition worsens, rest or night pain is common. Sometimes, limping is a feature.
- Swelling around the ankle.
- Tenderness to touch over the talus.
These symptoms can mimic other conditions, such as stress fractures in other bones, joint swelling or tendonitis, making diagnosis challenging.
Other possible causes of pain at the front of the ankle include navicular stress fracture, ankle arthritis, tibialis posterior tendonitis, mid-foot arthritis, and tarsal coalition.
Diagnosis of Stress Fracture in Talus
Early diagnosis is critical to preventing the progression of a stress fracture.
Clinical Assessment: Your doctor will take a history of your pain and examine your ankle to determine whether a stress fracture in talus is possible.
Imaging Studies:
- X-rays: Although X-rays may not show a stress fracture in the early stages, they can help exclude other conditions, such as ankle or mid-foot arthritis or tarsal coalition.
- MRI: Highly sensitive for detecting early stress injuries and assessing other causes, including arthritis and tendonitis.
- CT Scan: This may provide more details of a fracture line, which can determine the type of treatment.
A doctor’s assessment is also essential to determine possible causes such as overtraining, biomechanical factors and poor bone health.
Treatment of Stress Fracture in Talus
Treatment aims to relieve stress on the bone, promote healing, and prevent recurrence. We generally recommend conservative management in most cases of talus stress fracture.
Conservative treatment
Generally, we suggest immobilisation in a CAM walker boot for 6 weeks to reduce stress on the talus and allow the bone to heal. In more severe cases, non-weight bearing with crutches is required.
Treatments used for talus stress fractures include the following:
- Rest and Activity Modification: Avoid weight-bearing activities to allow the fracture to heal. Non-weight-bearing exercises like swimming and upper body weights may be recommended.
- Immobilisation: A CAM walker boot may reduce stress on the talus and allow healing.
- Bone healing treatments: Sometimes, we use other treatments to help the bone to heal. LIPUS therapy can stimulate bone healing in stress fractures, particularly in the early stages. Also, it is critical to optimise calcium and vitamin D intake. Sometimes, blood tests are needed to determine Vitamin D status.
After six to eight weeks, you can transition out of the CAM boot. Physiotherapy is started to improve ankle range of motion and calf strength. Your doctor will advise on a graduated return to running programme over 6 weeks. However, in some cases, returning to running may take longer.
Surgical treatment
Surgery is rarely needed for a talus stress fracture. Cases that may require surgery include a complete stress fracture involving the talar head and neck or a poorly healing stress fracture involving the talar body. Your doctor should guide you on the necessity for surgery.
Other Frequently Asked Questions about Stress Fracture in Talus:
What other treatments are used in Talar Stress Fractures apart from rest in a boot?
Generally, we recommend crosstraining to maintain fitness conditioning, and Vitamin D and Calcium supplementation. Sometimes, we use LIPUS therapy or focussed shockwave to assist in healing.
Final word from Sportdoctorlondon on Stress Fracture in Talus
Stress fractures of the talus are rare but impactful injuries, often resulting from repetitive strain and overuse. Early diagnosis, appropriate treatment, and a gradual return to activity are essential for full recovery. If you think you have a talar stress fracture, see your doctor.
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