![]() 7 Therefore, the movement and the positioning of the ankle joint at the time of injury appear to be more important than the type of footwear being used.Ĭlinically, up to 40% to 50% of lateral process fractures can be missed due to similar presentation as ankle sprains, even in the absence of distracting injuries. 12 However, Kirkpatrick et al reported a higher incidence of these fractures in snowboarders using hard boots as well. 11 One postulated reason behind their high incidence in snowboarders is the use of soft boots (70%), which results in more flexibility around the ankle joint leading to higher risk of foot and ankle injuries. Hawkins postulated that the avulsion of the lateral process caused by the pull of the lateral talocalcaneal ligament might be another contributing mechanism however, cadaveric and clinical studies do not clearly demonstrate this suggestion. 10 However, there is no disagreement that dorsiflexion plays the key role at the time of injury. 9 Funk et al, in another cadaveric study, suggested that a combined eversion and dorsiflexion might also play an important role resulting in these fractures. 8 Boon et al, in their cadaveric study, proposed that some degree of external rotation is also required to produce this type of injury. 5 This results in a lateral shift of the talar head, an upward shift of the lateral process of the talus on the posterior articular surface of the calcaneum and loss of congruity of the posterior articulation. The suggested mechanism is thought to be a consequence of forced dorsiflexion and inversion of a fixed pronated foot. Lateral process fractures are usually a result of high-energy injuries. 2- 4 This article aims to provide an overview of fractures of the lateral and posterior processes of the talus. 1 Factors that can affect the outcomes of these fractures are the extent of initial articular damage, the accuracy of the reduction and the subtalar joint stability. Delayed diagnosis and treatment can potentially lead to poor outcomes, resulting in long-term pain, disability, nonunion and degenerative changes. Their management depends on the type, size of the fragment, degree of displacement, subtalar joint involvement and the articular surface lesion. They are uncommon and frequently missed due to difficulty in visualizing them on plain radiographs and low level of suspicion. Fractures of the lateral and posterior processes are considered to be peripheral talar fractures. ![]() ![]() Skalski, : ).įractures of the talus are uncommon and they comprise 3.4% of foot and ankle fractures and 0.32% of all fractures in the human body. Restoring the co-ordination or proprioception of the ankle through balance or wobble board exercises should be done regularly.Anatomy of the talus (reproduced courtesy of Dr Matt. If the ankle has been immobilized in a cast then mobility exercises will be important initially. Returning to normal trainingĪ gradual rehabilitation program to strengthen the ankle should be done. This can be training errors, poor technique or simply doing too much too soon. Identifying the causes of the stress fracture in the first place is important. Treatment usually involves six weeks immobilization in a plaster cast.Ī surgeon may operate to remove the lateral process of the talus bone as this can speed up the healing process.īiomechanical correction of any overpronation with orthotic inserts is done if required. In other words rolling in at the same time as pointing the foot downwards.įor example, when a Pole Vaulter plants the pole late making their foot land too far forwards. The talus is more susceptible to stress fracture when the ankle repeatedly overpronates and plantar flexes. The talus is a tarsal bone in the ankle which sits on top of the calcaneus or heel bone and supports the tibia and fibula shin bones. Bone scans and CT scans can confirm the diagnosis as a stress fracture is unlikely to show up on an X-ray until healing has begun.This is a small canal where nerves pass into the ankle. There is likely to be tenderness and possibly swelling over the sinus tarsi.Symptoms get worse with exercise, particularly running, and ease with rest.Symptoms of a stress fracture of the talus develop gradually over time and include:
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