The talus is a sesmoid bone between the calcaneum below and ankle mortise above. The neck of talus is a hypovascular junction. Stress fracture of the talus is commonly seen in footballers and track/ field athletes.
The talus is more susceptible to developing a stress fracture when the ankle is repeatedly overpronated and plantar flexed or rolling in and flattening at the same time as pointing the foot downwards. This movement is seen in pole vaulters who plant the pole too late making the foot land too far forward at take off.
Symptoms include pain on the outside of the ankle which will develop gradually. The pain gets worse with activity particularly weight bearing while walking or running. Tenderness is felt on palpation and visible swelling around the sinus tarsi (a small canal where nerves passes into the ankle) area.
Bone scans and CT scans is needed to confirm the diagnosis as a stress fracture is likely to be missed in an X-ray until healing has begun.
Conservatively such fractures can be treated with six weeks immobilization in a plaster cast. At times surgical removal of the lateral process of the talus bone is needed to speed up the healing and rehabilitation process.
If a biomechanical fault is observed like hyperpronated foot, correction with an orthotic inserts is done. Identifying the causes of the stress fracture in very important as it may be as a result of overtraining of sudden increase in intensity of training.
A complete rehabilitation program should be designed under a specialized physiotherapist to strengthen the ankle and foot muscles and achieve complete range of motion of ankle and subtalar joint. Proprioception and balance exercises are taught to the patient to avoid reoccurrence of the symptoms. Patient should undergo Speed, agility and endurance training during the later phase of rehabilitation. If the patient was immobilized, still he/she should undergo rehabilitation to avoid injuring the ankle and soft tissues around it.