Talar Neck Fracture - A Patient's Story
So, you have an incomplete fracture in your talus bone.
Treatment of a talar fracture is incredibly important and should not be taken lightly. If you have fallen, been in a car accident, had a sports injury, etc that has even the slightest possibility of involving the talus bone - take it incredibly seriously. I would even go as far to say, if you have any injury with any part of your foot, from any accident - do not mess around.
The first thing I'd do is see an orthopedic surgeon. If possible, and time allows, do research and find one that focuses on foot injuries or one that specializes in sports injuries (even if yours is not sports related). Even if neither of those is available, still go to an orthopedic surgeon.
The second thing I'd do is to get a MRI. They are more expensive than an x-ray, but severe fractures can be missed on an x-ray based on the complicated shapes and close proximity of the foot bones. Getting a MRI from the start will show the entire foot from all angles and expose any hidden fractures.
The third thing I'd do is to get a plaster cast, not a removable cast. While a plaster cast is not as nice as a removable one, it is crucial for healing of a talar fracture to not move, even the slightest. Since this bone is the hinge of your foot, it is a tricky task to hold still.
The fourth thing I'd do is NOT walk on it. Just don't do it. Wait a minimum of 6 weeks, if not a full 8. Whatever you do, don't rush it. Foot fractures are not simple to heal. In the event of any fracture, blood is key in the healing process. In a perfect body the amount of blood flowing to the foot is actually minor. With one fracture in a foot bone it is going to take time due to normal limited blood. In the event of multiple fractures, the healing process is even longer due to the limited about of blood available for healing. Be patient.
Breaking one's foot is not fun but hopefully by taking the right steps (ha!), it will heal and never again will you take walking for granted.
Now, my friends are probably wondering why I wrote all this out. OY! Josh asked me to write this a long time ago as something that someone (specifically a patient) could find on the internet if they typed these issues (talar neck fracture, talar fracture, talus bone fractures) into a search engine: Google, Bing, Yahoo, etc. I had been putting it off for so long, it seemed fitting to write it on the 1-year anniversary of when I broke my talus bone.
His/our reason for writing this is so we can give direction (via the internet) to patients just starting their own broken foot adventure. That way, whomever they are can learn from what I went through:
For those who don't know - I broke my foot falling onto concrete one year ago today. I went to the podiatrist first and got x-rays. He saw 2 incomplete fractures to my talus bone, one on the right side and one on the left, with a tiny bit of bone holding it together. After 2.5 weeks in a removable cast, the podiatrist let me walk on it, even though it hurt. After 8 weeks and me still in intense pain, he said he thought I had a talar dome lesion, but to keep an eye on it. After 12 weeks and me literally crying while walking, he had me get a MRI. The MRI showed a 3rd fracture to the neck my talus bone that got missed on the x-rays. The podiatrist sent me to non-load bearing PT, prescribed inflammatory medicine and put me back in the removable cast.
Thankfully/Finally, after all we had been through up until this point, this wasn't good enough for my husband. He had my MRI results sent to an orthopedic surgeon for a second opinion. The orthopedic surgeon he found, who specialized in foot and sports medicine, said if I had gone to him when this first happened he would have immediately put me in a plaster cast and had me not walk on it for a minimum of 8 weeks. He then prescribed me to immediately stop PT because due to my fracture being on the neck of the talus, any movement at all was re-breaking the bone, causing continual micro-fractures. He also had me stop all inflammatory medicines. Since the foot already has a limited blood supply, I needed all the extra swelling and blood I could get down there to help heal the fracture. He would have put me in a plaster cast right then but since I had already been in this ordeal for 3.5 months, he took pity on me and let me remain in the removable cast if I made sure to not bend my foot or walk on it for (another) 8 weeks. After that, it was finally deemed "healed" (with the promise of pain for up to a year. And yes, it still hurts, 1 year later. It is my "new normal.") and I was able to go to PT and learn how to walk all over again. The whole ordeal (only) took 6 months.
Again, the first three months of this injury we had researched every possible which way on the internet, trying to find answers or direction for fractures in the talus bone, then for talar dome lesions, etc. Hard to believe, but nothing on the internet was giving us any real information or helping my pain. It wasn't until we met with the orthopedic surgeon and were given more direction that we were able to know what was really going on.
I know, I know, this is old news to my friends, so sorry. I'll go back to something completely differenter soon.
Hi - Im a bit older than you and fractured my talus bone 2 months ago and loved reading your story! I went to an incompetent orthopedic at first who never even looked at my foot .. he just looked at the scan and told his assisatant to cast me. I only had a cast on for 3 weeks. he said it was non displaced. I went to someone else who said it was in fact displaced. who knows. I trust the second guy because he actually looks at my foot I am sad to hear of all your misery with this and hope I do not have pain after a year- I am walking a bit with a boot cast - tried walking yesterday but it was so sore that I decided it must not be healed enough yet and put the boot back on. (Then tripped over a box at work today and wonder if I complicated the fracture- seems ok but sore... I hate not living life to its dullest and this is horrible. Thanks for sharing dear.
I appreciate both of the above ladies sharing their stories. I would like to add my experience, 3 months out in hopes that someone else may offer advice or suggestions. I am perplexed, and not sure what to do next. I was in a head on car accident 3 months ago. I sustained a broken talus bone and sprained ligaments in my right ankle. I also had four broken displaced (they were broken clean through) ribs on the left side, contusions and swelling to my right knee, a sprained a/c(clavicle) ligament, concussion, whiplash, and multiple soft tissue injuries. In the ER, I was x-rayed and a CT scan of my ankle confirmed the presence of a non-displaced comminuted fracture of the talar neck (lateral side), a non-displaced fracture of the medial side of the talus at the anterior sub-talar joint, and an avulsion fracture on the medial aspect posteriorly that was of "indeterminate age". The orthopedic surgeon on call who consulted that evening did not come to the ER to examine me, but discharged me to home that evening at approximately 1:00 a.m., with instructions to be at his office at 8:00 a.m. the next morning. I was discharged with crutches (with four broken displaced ribs!!) no wheelchair, and no walker. I was heavily medicated with Percocet, and blacked out because of the intense pain as my family tried to assist me into my husband's pickup truck, which was too hard for me to get into in my condition. My son had to go home and come back with a different vehicle that was lower in order to get me home. Needless to say, I did not feel that I could put myself or my family through another experience like that only a few hours later, so we called the orthopedic doctor's office to ask for an order for a wheelchair, walker, etc. so that transporting me would not be so painful and dangerous. They obliged by making me the "next available" appointment, which was 6 days later. In the meantime, my ankle and knee were swollen up like a melon, and I was non-weightbearing, however, the only immobilization I had was a home-made splint made in the ER with an ace bandage to hold it on. When I did see the ortho doc 6 days out, he felt that I did not need to be casted. He confused me by saying that the break was medial, then lateral, then medial again...I was convinced that he had not read my x-ray and CT reports. He didn't seem to be aware that I was also suffering from four broken ribs, whiplash, shoulder pain, and a painful knee. He made it clear that he only wanted to see me for my ankle issue. ( I thought orthopedic doctors were specialists with all bone and joint problems). He gave me a walking boot and instructed me to begin putting 20% of my weight on my right foot at 3 weeks out, then to add an additional 10% each week thereafter. I saw him again four weeks later, at which time he instructed me to begin weaning off the crutches at 6 weeks out, and to be completely off by 9 weeks. At each of my three appointments with this doc, I emphasized to him that my pain was coming from the medial side of my foot, which became very noticeable as I began to weight bear and to attempt walking normally on my foot at the 9 week point. He continued to insist that my only fracture was lateral, even though the CT report of the night of the accident mentioned three separate fractures. He stated that I was probably experiencing "referred pain" on the medial side, since there is a nerve in that area. (HMMM...I have always had that same nerve in that area, but haven't always had pain there) We agreed that I should see an orthopedic foot specialist for a second opinion. A follow-up CT was done in preparation for the visit to the ortho foot specialist. It showed partial healing in some areas, non-union in others, primarily on the lateral side. The foot doc quickly stated that I should have surgery to remove the non-union fragment of the talar neck. He stated that he would have done it initially, and also stated that he didn't think that the lack of immobilization had changed the course of the healing. He mentioned that failure to remove the floating piece of the talar neck would probably increase the liklihood of arthritis in the joint, and could result in having the ankle fused at some point. He anticipated that this surgery would require two weeks non-weight bearing followed by several more weeks in a walking boot. His response to my continued complaints of pain on the medial side of my foot was that he felt that it was probably "plantar fasciitis" causing that. Again, I must stress that two of two CT reports noted not one, but TWO fractures on the medial side, which both docs seemed to completely ignore, along with my complaints of pain primarily on the medial side. I read with interest your comments about the MRI being able to diagnose fractures that were obscured by x-ray and CT. I feel that I should have an MRI at this point, but am not sure how to proceed. After having two doctors ignore the CT reports, and what I'm telling them consistently, I feel I need still another evaluation. I am not anxious to undergo surgery when I feel that this still hasn't been worked up adequately. I make my living on my feet, and am very disgruntled at the complete lack of interest that either of my doctors this far have shown about getting me back on my feet and back to work. I feel I'm being treated like a "dummy" and without respect. I am 50 years old, a licensed physical therapist, and am no dummy, but I can't get them to listen! Anyone with advice on how to proceed from here can e mail me...I'm interested in what your advice and experiences with talar fractures are! Thanks!