Orif Talus

/ What we treat / Surgery / Ankle / Orif talus /

The talus bone is the front wedge shaped bone of the ankle joint and it articulates (joins) with the end of the tibia (shin bone) and the fibula (smaller lower leg bone) to make up the talocrural (ankle) joint. Because the talus is the main connection between the foot and leg, it provides a large amount of stability and mobility. The neck of the talus also joins with the calcaneus (heel bone) and navicular (small foot bone) and this area is the most susceptible to fractures. Talus fractures are commonly due toa dorsiflexion movement (the toes are pulled up towards the leg. If this is done severely such as following a fall from height or during a road traffic accident then a fracture of the talus may occur. Talus fractures can be categorised depending on the extent of the injury:

Type 1: Stable fracture of the talus

Type 2: Displaced fracture of the talus which dislocates the joint in the ankle formed by the talus and calcaneus

Type 3: Displaced fracture of the talus which dislocates both the subtalar and talocrural joints

Type 4: Displaced fracture of the talus which dislocates the joint in the ankle formed by the talus and the navicular bone

If you have fractured your talus, you will notice some of the following symptoms:

Pain when moving the ankle
Crepitus(grating/ clicking noises) on movement if broken bone has gone into the joint
Swelling
Restricted range of movement
Tender to touch the surrounding area

For a type 1 talus fracture, conservative management is often sufficient. This will involve the ankle being placed in a below-knee cast or boot for 8-12 weeks and you will be non-weight bearing for the first 6 weeks after the injury. However, if the fracture is unstable as it is in types 2-4, you may require open reduction internal fixation (ORIF) surgery. ORIF is a surgical procedure where the affected joint is opened up and the bones are realigned to its normal position (open reduction) and metal pins, nails, plates or screws are used to maintain this correct alignment (internal fixation).

Above: Therapist explaining ankle condition to client

Physiotherapy prior to ORIF talus

The talus has a very poor blood supply and because of this following a fracture, it is common for the foot to be deprived of a blood supply following a fracture (avascular necrosis). Therefore it is essential that you participate in a full rehabilitation programme before and after surgery to minimise this type of complication. Before the operation you be placed on a waiting list and until then it is important to keep the strength and range of movement in the surrounding joints to give you the best chance of recovery and limit any further complications. At Physio.co.uk, we can provide a specially designed physiotherapy programme to be carried out before and after your operation. Physiotherapy treatment before surgery may include:

Cryotherapy (ice treatment) to reduce swelling
Compression techniques to reduce swelling
Taping of the ankle to provide support, reduce swelling and minimise the risk of further injury
Strengthening of other muscle groups in the lower leg
Range of movement exercises in other joints
Activities to maintain cardiovascular fitness including swimming and cycling
Preparation for rehabilitation immediately after surgery

Above: Soft tissue friction massage of the achilles tendon

Symptoms after ORIF talus

Following your operation, you may experience some of the following symptoms which the physiotherapists at Physio.co.uk will help you to manage:

Stiffness
Swelling
Temporary pain
Temporary numbness and/or pins and needles around the foot and ankle if the nerves supplying the area have been disrupted during the operation
A scar from where the surgeon has entered the joint

Physiotherapy following ORIF talus

Following your operation, you will be placed in an aircast boot or below the knee plaster and you will be unable to put weight through your foot (weight-bear) for at least 2 weeks. After 4-6 weeks you will be able to put some weight through it (partial weight-bearing) and you should be fully weight-bearing after 8 weeks.

Above: Mobilisations and stretches applied to the connective tissues in the ankle

Weeks 1-2

At this stage, your physiotherapy programme will consist of:

Pain control
Active exercise of the foot joints
Cryotherapy treatment to reduce the swelling
Elevation of the foot to reduce swelling
Upper limb exercises
Re-educating your gait (walking pattern) using crutches
Teaching you simple techniques such as how to move from the bed to a chair without weight-bearing

Weeks 2-4

You may now be able to weight using just your toes (toe-touch weight-bearing) if you feel able. Physiotherapy at this stage will focus on:

Simple strengthening and range of movement exercises
Non-weight-bearing cardiovascular activity such as cycling in sitting and rowing
You will also be taught how to walk using your crutches and the ‘toe-touch’ method
Progression of your upper limb exercises
Strengthening and stretching of the unaffected leg
Continuing with Cryotherapy and elevation to reduce swelling

Weeks 4-6

You should now be able to partially weight-bear and begin a more intense physiotherapy programme at Physio.co.uk including:

Range of movement and strengthening of the ankle joint
Gentle mobilisations to increase movement at the joint
Progression of cardiovascular activity levels
Upper limb exercises
Education on your walking pattern for partial weight- bearing

Weeks 6-10

After 8 weeks, your bone should have fully healed and your plaster will be removed. You should now be able to fully weight-bear and your programme at Physio.co.uk will include:

Re-education of your normal gait
Progression to more dynamic and functional strengthening and range of movement exercises
Mobilisations of the ankle joint and other joints of the foot that may have become stiff
Introduce swimming as a cardiovascular and non-weight-bearing activity
Upper limb activity
Maintaining activity levels of the unaffected leg

Summary

ORIF talus is a surgical procedure which is used to treat a fractured talus bone in the ankle. The operation involves realigning the broken bone and fixing the ends together with metal wires or pins. Success rates of the surgery are high if a good level of strength and fitness shown before the operation and this is maintained and improved following surgery. An individualised physiotherapy programme designed by Physio.co.uk can help you to optimise your recovery and return to your previous level of sport or activity as soon as possible. To book an appointment with one of the specialist physiotherapists at Physio.co.uk, call 0330 088 7800 today!

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