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What is it?

The talus is the primary articulation point in the ankle. Located between the heel bone (calcaneus) and the two bones of the lower leg (the tibia and fibula). It sits anteriorly and allows for pointing (plantarflexion), extending (dorsiflexion) and tilting the foot relative to the lower leg. Fracturing the lateral talus has been coined the “Snowboarder’s Fracture” due to the high prevalence in the snowboarding population.

Talus fractures can be challenging to diagnose, as they often mimic the symptoms of a sprain. Without timely treatment, these fractures can lead to long-term issues such as arthritis or joint instability. Understanding the nature of this injury is crucial for effective management and recovery.

Signs & Symptoms

The symptoms of a lateral talus fracture can often be confused with those of a severe ankle sprain, making diagnosis challenging. Key symptoms include:

  • Acute pain on the outer side of the ankle, often immediately following a fall or twist.
  • Swelling and bruising around the ankle joint.
  • Tenderness upon touching the lateral (outer) side of the ankle.
  • Difficulty weight-bearing or walking on the affected foot, with some people experiencing a complete inability to walk.
  • Limited range of motion in the ankle due to pain, particularly when trying to rotate or dorsiflex (move the foot upwards).

It’s important to seek a thorough assessment from a healthcare provider to rule out other potential injuries, as these symptoms overlap with those of an ankle sprain or ligament injury.

Causes and Contributing Factors

Snowboarder’s ankle occurs predominantly in snowboarding and other sports where the foot is in a fixed position. Several factors increase the risk:

  • Snowboarding position: When snowboarding, the feet are strapped into the board, which reduces ankle mobility and increases the likelihood of trauma to the talus during falls.
  • High-impact landings: Jumps and aerial stunts can create significant impact forces, which can transmit directly to the ankle joint, increasing fracture risk.
  • Foot positioning in boots: Stiffer snowboard boots restrict ankle movement, which provides stability but can also result in concentrated forces on the ankle bones, especially the talus.
  • Falls with eversion (outward turning) of the ankle: Falling onto an outwardly rotated foot often forces the lateral side of the talus into a vulnerable position.

While snowboarders are particularly prone to this injury, it may also occur in other high-impact sports or accidents where similar forces are applied to the ankle.

Grading

Lateral talus fractures are classified based on the degree of displacement and damage to surrounding structures:

  1. Non-displaced fracture: The bone remains aligned, with no significant movement from its original position.
  2. Minimally displaced fracture: Slight displacement of the fracture, but the bone pieces are still largely in place.
  3. Displaced fracture: The fracture is significantly displaced, potentially impacting blood supply to the area or causing damage to nearby structures.

Non-displaced fractures generally have a better prognosis, as the alignment allows for better healing. Displaced fractures, however, often require more extensive intervention to prevent long-term complications.

Prognosis

The prognosis for a lateral talus fracture varies depending on the severity, timeliness of diagnosis, and adherence to treatment protocols. In cases of non-displaced fractures, most individuals recover well with conservative treatment and physiotherapy. However, displaced fractures may increase the risk of complications such as:

  • Avascular necrosis (AVN): This occurs when the blood supply to the talus is disrupted, potentially leading to bone death and long-term damage.
  • Post-traumatic arthritis: Joint instability or poor healing can lead to arthritis within the ankle joint, causing pain and stiffness over time.
  • Reduced ankle mobility: Long-term restrictions in ankle range of motion may affect gait and activity levels.

Timely treatment significantly improves outcomes, with full recovery typically taking several months to a year, depending on the injury’s severity.

Treatment

Treatment for Snowboarder’s ankle ranges from conservative approaches to surgical intervention, based on the type and extent of the fracture. Physiotherapy plays a central role in recovery, especially in restoring function and strength.

Conservative Management

For non-displaced fractures, conservative management is often effective:

  • Rest and immobilisation: The ankle is typically immobilised in a cast most commonly for six to eight weeks, allowing the bone to heal while limiting unnecessary movement.
  • Elevation and icing: Reducing swelling and managing pain are key aspects of early treatment.
  • Non-weight-bearing: Use of crutches or a knee scooter is recommended to avoid weight-bearing until the fracture shows signs of healing, usually determined by X-rays.

Surgical Intervention

In cases of displaced fractures, surgery may be required to realign and stabilise the bone fragments. Procedures may include:

  • Open reduction and internal fixation (ORIF): This involves realigning the bone and securing it with screws or plates. ORIF is common for stabilising the talus in complex fractures.
  • Fragment excision: the removal of bony fragments.

Surgery is typically followed by a period of immobilisation, similar to conservative management, and rehabilitation under the guidance of a physiotherapist.

Physiotherapy and Rehabilitation

Physiotherapy is integral to recovery, particularly in restoring mobility, strength, and stability in the ankle. A physiotherapist will tailor exercises and treatments based on the stage of healing and individual needs.

  • Range of motion (ROM) exercises: As soon as it’s safe, gentle ROM exercises help prevent stiffness in the joint. These may include dorsiflexion and plantarflexion (moving the foot up and down) as well as gentle side-to-side movements.
  • Strengthening exercises: Once the bone has sufficiently healed, strengthening exercises for the ankle, foot, and surrounding muscles (like the calf and shin) are introduced. These help to support the ankle and improve overall stability.
  • Balance and proprioception training: These exercises, often using equipment like a wobble board, help restore the body’s ability to sense the ankle’s position. This is essential for preventing re-injury, especially in activities like snowboarding.
  • Gait retraining: If walking mechanics are impacted by the injury, physiotherapy can assist in correcting gait abnormalities and ensuring even weight distribution.
  • Return-to-sport training: For snowboarders or athletes, physiotherapy will eventually include sport-specific drills and activities to prepare for a safe return to their sport. These may include controlled landings, plyometric exercises, and agility drills.

Adjunct Therapies

Additional therapies can assist in managing symptoms and promoting healing:

  • Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or other medications may be prescribed to manage pain and inflammation. However, use should be monitored, as NSAIDs may interfere with bone healing.
  • Hydrotherapy: Water-based exercises are beneficial in the later stages of recovery, allowing for strengthening and mobility exercises with minimal weight-bearing stress.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.

References:

  1. McCrory, Paul M.B.B.S.*; Bladin, Chris M.B.B.S., B.Sc.*. Fractures of the Lateral Process of the Talus: A Clinical Review. “Snowboarder’s Ankle”. Clinical Journal of Sport Medicine 6(2):p 124-128, April 1996.
  2. Russell TG, Byerly DW. Talus Fracture. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539687/