Anterior ankle impingement results from an impingement of the ankle joint by a soft tissue or osteophyte formation at the anterior aspect of the distal tibia and talar neck. It often occurs secondary to direct trauma (impaction force) or repetitive ankle dorsiflexion (repetitive impaction and traction force). Chronic ankle pain, swelling, and limitation of ankle dorsiflexion are common complaints. Imaging is valuable for diagnosis of the bony impingement but not for the soft tissue impingement, which is based on clinical findings. MR imaging and MR arthrography are helpful in doubtful diagnoses and the identification of associated injuries. Recommended methods for initial management include rest, physical therapy, and shoe modification. If nonoperative treatment fails, arthroscopic bony or soft tissue debridement both offer significant symptomatic relief with long-term positive outcomes in cases that have no significant arthritic change, associated ligament laxity, and chondral lesion.
Ankle; Impingement; Bony; Soft Tissue; Anterior; Ankle Pain; Chronic; Sport; Arthroscopy; Foot and Ankle; Musculoskeletal
To present the case of an intercollegiate swimmer with a stage IV lateral talar dome injury and associated bony fragments.
Lack of distinct diagnostic symptoms, low index of clinical suspicion, and the difficulty of visualizing the early stages of this injury on standard x-rays cause frequent misdiagnosis of talar dome lesions.
Ganglion cyst, with inflammatory synovitis secondary to rupture of cyst; loose bodies from previous occult fracture; osteochondral fracture.
Initial treatment with nonsteroidal antiinflammatory drugs and a posterior splint for comfort, followed by arthroscopic excision of loose bodies with abrasion and drilling arthroplasty.
Patient presented to the team physician for care of acute left medial ankle pain after the athletic trainer had attempted to rupture a ganglion cyst on the anterolateral aspect of the patient's ankle.
Increased clinical suspicion is necessary to correctly diagnose osteochondral lesions, particularly in the early stages. Aggressive treatment of talar dome lesions has a good success rate and may be an attractive option for competitive athletes.
ganglion cyst; inflammatory synovitis; osteochondral fracture
The purpose of this case report is to describe the clinical presentation of a patient who had a lateral talar process fracture due to a wakeboarding injury.
A 29-year-old male patient sustained a left ankle injury when the front edge of his wakeboard became immersed in the water. As he fell forward, his foot remained attached to the board, leading to inversion and dorsiflexion stress of the ankle. He presented to a chiropractic clinic with diffuse ankle swelling, tenderness, and pain at the distal aspect of the lateral malleolus. Mild ligamentous laxity of the lateral supporting structures was observed during the physical examination.
Intervention and Outcome
Static and stress radiographs of the left ankle demonstrated a small (McCrory-Bladin type 1) lateral talar process fracture without evidence of gross instability. The patient was referred to a local orthopedic medical specialist for immobilization of the ankle. The patient was treated conservatively with an air cast walking boot for 2 weeks (non–weight-bearing) followed by a 2-week period of partial weight-bearing. At 6 weeks following the injury, a repeated radiographic examination demonstrated complete healing of the fracture. The patient reported minimal tenderness and normal ankle function.
Because of the similar mechanism of injury to those sustained in snowboarding, this case demonstrates the need for increased awareness of lateral process fractures in wakeboarders.
Chiropractic; Athletic injuries; Diagnostic imaging; Radiology; Talus; Snowboarding
Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling.
A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport.
Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients.
Methods: The observation period for this study started on October 1, 2003 and ended on May 1, 2004 and included 30 air rescue missions. Data and information were collected prospectively.
Results: The Air Mercy Service in Cape Town Province responded to 30 requests for help. Twenty five accidents were attributed to inability to detach the kite from the harness. Injuries occurred in five incidents and included fractures of the upper arm, ribs and ankle, and lacerations and contusions to the head and neck. Two patients suffered from hypothermia and one experienced severe exhaustion. All surfers were rescued successfully and there were no fatal accidents.
Discussion: The risk potential of this new sport is unclear. Dangerous situations can occur despite proper training and safety precautions due to unpredictable conditions and difficulties with equipment. Safety should be stressed. Surfers should sailing with a fellow kiter and should wear a life vest. More efforts must be taken to make this booming new water sport safer.
From 1993 to 2002, we treated nine patients for neglected or mal-reduced talar fractures. Average patient age was 39 (20–64) years and average follow-up 53 months. The time interval between injury and index operation ranged from 4 weeks to 4 years. Surgical procedures included open reduction with or without bone grafting in six cases, open reduction combined with ankle fusion in one case, talar neck osteotomy in one case, and talar neck osteotomy combined with subtalar fusion in one case. All cases had solid bone union. One patient developed avascular necrosis of the talus needing subsequent ankle arthrodesis. In six patients, adjacent hindfoot arthrosis occurred. The overall AOFAS ankle–hindfoot score was in average 77.4. We conclude that in neglected and mal-reduced talar fractures, surgical treatment can lead to a favourable outcome if the hindfoot joints are not arthritic.
There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences could result in disability and lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences and the associated chronic results, ankle sprain recurrence prevention is important.
To evaluate the effect of a proprioceptive balance board training programme on ankle sprain recurrences, that was applied to individual athletes after rehabilitation and treatment by usual care.
This study was designed as a randomized controlled trial with a follow-up of one year. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain up to two months prior to inclusion, were eligible for inclusion in the study. The intervention programme was compared to usual care. The intervention programme consisted of an eight-week proprioceptive training, which started after finishing usual care and from the moment that sports participation was again possible. Outcomes were assessed at baseline and every month for 12 months. The primary outcome of this study was the incidence of recurrent ankle injuries in both groups within one year after the initial sprain. Secondary outcomes were severity and etiology of re-injury and medical care. Cost-effectiveness was evaluated from a societal perspective. A process evaluation was conducted for the intervention programme.
The 2BFit trial is the first randomized controlled trial to study the effect of a non-supervised home-based proprioceptive balance board training programme in addition to usual care, on the recurrence of ankle sprains in sports. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains. Results will become available in 2009.
Ischemic nontraumatic spinal cord injury associated with surfing is a novel diagnosis believed to be related to prolonged spine hyperextension while lying prone on the surfboard. Only 9 cases have been documented. This report features possible risk factors, etiology, diagnostic imaging, and outcomes of surfer's myelopathy.
A 37-year-old man developed T11 American Spinal Injury Association (ASIA) A paraplegia shortly after surfing. The clinical history and magnetic resonance imaging findings were compatible with an ischemic insult to the distal thoracic spinal cord. Our patient did not have any of the proposed risk factors associated with this condition, and, contrary to most reports, he sustained a complete spinal cord lesion without neurological recovery by 8 weeks post injury.
Surfer's myelopathy, because of its proposed mechanism of injury, is amenable to medical intervention. Increased awareness of this condition may lead to early recognition and treatment, which should contribute to improved neurological outcomes.
Spinal cord ischemia; Ischemic myelopathy; Paraplegia; Diffusion magnetic resonance imaging; Surfing
Medial impingement syndrome of the ankle is common in the athletic population. A marginal osteophyte on the leading edge of the medial talar facet and a corresponding “kissing” osteophyte on the tibia, in front of the medial malleolus, may abut and cause pain and limited dorsiflexion.
Palpation of the talar osteophyte and standard imaging—especially, the oblique view of the foot—are useful in making the diagnosis. Surgical removal of the osteophyte may be necessary.
Ankle impingement is commonly seen in running and jumping sports, especially if the athlete has a subtle cavus foot. It may be associated with ankle instability, osteochondritis dissecans of the talus, and stress fractures of the foot.
ankle; impingement; sports injuries; talus; medial malleolus
Chronic ankle instability (CAI) is a common orthopaedic entity in sport. Although other risk factors have been studied extensively, little is known about how it is influenced by the osseous joint configuration.
To study the effect of osseous ankle configuration on CAI.
Case–control study, level III.
Radiological examination with measurement of lateral x rays by an independent radiologist using a digital DICOM/PACS system.
A group of 52 patients who had had at least three recurrent sprains was compared with an age‐matched and sex‐matched control group of 52 healthy subjects.
Main outcome measures
The radius of the talar surface, the tibial coverage of the talus (tibiotalar sector) and the height of the talar body were measured.
The talar radius was found to be larger in patients with CAI (21.2 (2.4) mm) than in controls (17.7 (1.9) mm; p<0.001, power >95%). The tibiotalar sector, representing the tibial coverage of the talus, was smaller in patients with CAI (80° (5.1°)) than in controls (88.4° (7.2°); p<0.001, power >95%). No significant difference was observed in the height of the talar body between patients with CAI (28.8 (2.6) mm) and controls (27.5 (4.0) mm; p = 0.055).
CAI is associated with an unstable osseous joint configuration characterised by a larger radius of the talus and a smaller tibiotalar sector. There is evidence that a higher talus might also play some part, particularly in women.
Ankle sprain is a frequent injury in humans that results in pain, swelling and difficulty in walking on the affected ankle. Currently a suitable animal model resembling human ankle sprain is lacking. Here, we describe an animal ankle sprain model induced by ankle ligament injury (ALI) in rats. Cutting combinations of the lateral ankle ligament complex produced pain, edema and difficulty of weight bearing, thereby mimicking severe (grade III) ankle sprain in humans. Analgesic compounds, morphine and indomethacin, significantly reversed the reduced weight bearing, thus indicating that reduction of weight bearing is partially due to pain. The ALI model is a new ankle sprain model that may be useful for the study of ankle sprain pain mechanisms and treatments and for the screening of new analgesic drugs.
animal model; lateral ankle ligament injury; pain; weight bearing
Closed subtalar dislocations associated with talus and navicular fractures are rare injuries. We report on a case of a 43-year-old builder man with medial subtalar dislocation that was further complicated by minimally displaced talar and navicular fractures. Successful closed reduction under general anesthesia was followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 ;weeks. At 3 years post-injury, the subtalar joint was stable, the foot and ankle mobility was in normal limits and the patient could still work as a builder. However, he complained for occasionally mild pain due to the development of post-traumatic arthritis in subtalar and ankle joints. Our search in literature revealed that conservative treatment of all the successfully reduced and minimally displaced subtalar fracture-dislocations has given superior results compared to surgical management. However, even in cases with no or slight fracture displacement, avascular necrosis of the talus or arthritis of the surrounding joints can compromise the final functional outcome.
Osteochondral defects (OCDs) of the talus are a common cause of residual pain after ankle injuries. When conservative treatment fails, arthroscopic debridement combined with drilling/microfracturing of the lesion (bone marrow stimulation [BMS] procedures) has been shown to provide good to excellent outcomes. Not uncommonly, talar OCDs involve the borders of the talar dome. These uncontained lesions are sometimes difficult to visualize with the 30° arthroscope, with potential negative effect on the clinical outcome of an arthroscopic BMS procedure. The use of the 70° arthroscope has been described for a multitude of common knee, shoulder, elbow, and hip procedures. The purpose of this article is to show the usefulness of the 70° arthroscope in arthroscopic BMS procedures, pointing out which kinds of talar OCDs can benefit most from its use.
A 23-year-old recreational male athlete presented with intermittent pain of three weeks duration, localized to the left ankle. Pain was aggravated by walking, although his symptoms had not affected the patient’s jogging activity which was performed three times per week. Past history revealed an inversion sprain of the left ankle, sustained fifteen months previously. Examination showed mild swelling anterior to the ankle mortise joint while other tests including range of motion, strength and motion palpation of specific joints of the ankle were noted to be unremarkable. Radiographic findings revealed a defect in the medial aspect of the talus. An orthopaedic referral was made for further evaluation. Tomography revealed a Grade III osteochondral lesion of the talus.
It was determined that follow-up views be taken in three months to demonstrate if the lesion was progressing or healing. Within the three month period, activity modifications and modalities for pain control were indicated. Surgery was considered a reasonable option should conservative measures fail.
The present case illustrates an osteochondral lesion of the talus, a condition which has not previously been reported in the chiropractic literature. A review of the pertinent orthopaedic literature has indicated an average delay of three years in diagnosing the existence of this lesion.
Although considered rare, the diagnostic frequency of the condition appears to be on the rise due to increased awareness and the use of bone and CT scans. The osteochondral lesion of the talus deserves particular consideration by practitioners working with athletes due to its higher incidence within this group. This diagnosis should be considered in patients presenting with chronic ankle pain particularly when a history of an inversion sprain exists.
The purpose of this report is to increase awareness of this condition, and review diagnosis and management strategies.
osteochondral lesion; talus; osteochondritis dissecans; diagnosis; chiropractic; athletic injuries; ankle
Anterior ankle impingement with and without ankle osteoarthritis (OA) is a common condition. Bony impingement between the distal tibia and talus aggravated by dorsiflexion has been well described. The etiology of these impingement lesions remains controversial. This study describes a cam-type impingement of the ankle, in which the sagittal contour of the talar dome is a non-circular arc, causing pathologic contact with the anterior aspect of the tibial plafond during dorsiflexion, leading to abnormal ankle joint mechanics by limiting dorsiflexion.
A group of 269 consecutive adult patients from the University of Iowa Hospitals and Clinics who were treated for anterior bony impingement syndrome were evaluated as the study population. As a control group, 41 patients without any evidence of impingement or arthrosis were evaluated. Standardized standing lateral ankle radiographs were evaluated to determine the contour of the head/neck relationship in the talus. Two investigators made all the radiographic measurements and intra- and inter-observer reliability were measured.
34% of patients were found to have some anterior extension of the talar dome creating a loss of the normal concavity at the dorsal medial talar neck. A group of 36 patients (13%) were identified as having the most severe cam deformity in order to assess any correlation with coexisting radiographic abnormalities. In these patients, a cavo-varus foot type was more commonly observed. Comparison with a control group showed much lower rates of anterior-medial cam-type deformity of the talus.
Cam type impingement of the ankle is likely a distinct form of bony impingement of the ankle secondary to a morphological talar bony abnormality. Based on the findings of this study, this form of impingement may be related to a cavovarus foot type. In addition, there may be long term implications in the development of ankle OA.
Level of Evidence
Surfing is enjoyed by many people around the world. A common problem in surfers is back pain during the “take-off,” specifically the “pop-up.” This article describes each part of the “take-off, and introduces an alternative to the “prone pop up” - called the “knee pop-up.” This alternative is a suggested technique to alleviate the stress in the lumbar spine during surfing.
Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.
Ankle fracture; Joint manipulation; ASTYM treatment
Medial swivel dislocation, a variant of subtalar dislocation is uncommon. A 35 years old male presented after 6 weeks old injury to left ankle following motor cycle accident. He had pain, swelling around ankle and was unable to bear weight on left foot. Clinical examination revealed diffuse swelling and tenderness in mid foot region. His plain X rays and CT scan showed talonavicular dislocation with compression defect of the head of the talus. He was treated by open reduction and K-wire fixation. At 32 months follow up foot was painless, stable with normal range of ankle and subtalar motion.
Medial swivel dislocation; subtalar-subluxation; talonavicular dislocation
The effect on clinical safety of dampening articular mechanoreceptor feedback at the ankle is unknown. Injection of the ankle joint for pain control may result in such dampening. Athletes receiving intra‐articular local anaesthetic may therefore be at increased risk of sustaining ankle injuries, which are a common reason for missed sporting participation.
To determine the effect of intra‐articular local anaesthetic on movement discrimination at the ankle joint.
Prospective, randomised, double‐blinded, placebo‐controlled, cross‐over trial.
Australian Institute of Sport Medical Centre, Canberra, Australia.
Twenty two healthy subjects (44 ankles) aged 18–26 were recruited for the three visits of the study.
Subjects were tested for their initial movement discrimination scores using the active movement extent discrimination apparatus (AMEDA). They then received ultrasound‐guided intra‐articular injections of local anaesthetic (2% lignocaine hydrochloride) or normal saline, on two separate later occasions, before further AMEDA assessment.
Main outcome measures
Change in movement discrimination scores after intra‐articular injection of local anaesthetic or saline.
Movement discrimination scores were not significantly different from control ankles after injection of either local anaesthetic or saline into the ankle joint.
The intra‐articular injection of neither 2 ml lignocaine nor an equivalent amount of normal saline resulted in significant effects on movement discrimination at the ankle joint. These results suggest that injections of local anaesthetic into the ankle joint are unlikely to significantly affect proprioception and thereby increase injury risk.
ankle injection; proprioception; active movement discrimination; inversion
Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.
Congenital vertical talus; Flatfoot; Treatment; Genetics; Etiology
We have conducted a retrospective review of 19 patients for whom 20 separated ossicles of the lateral malleolus were excised arthroscopically. We examined the operating methods, findings, and overall results.
The patients’ indications for this procedure were as follows. The main complaints were pain alone; ossicle sizes were small and ankle instability was minimal. There were 12 ankles of 12 males and eight ankles of seven females. The patients’ average age was 17.6 years. A 2.7-mm, 30° arthroscope was inserted into the ankle joint through the anterolateral portal. Instruments were inserted through the accessory anterolateral portal, and ossicles were removed piece by piece. Talar tilt angles and anterior displacements were examined and compared before and after surgery by use of stress radiographs. Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scales were assessed pre and postoperatively.
All patients recovered their original levels of activity. The mean talar tilt angle changed from 6.1° ± 2.4° preoperatively to 6.0° ± 1.8° postoperatively (p = 0.93), and the mean anterior displacement changed from 5.9 ± 1.7 mm preoperatively to 6.1 ± 2.0 mm postoperatively (p = 0.42). Average JSSF ankle/hindfoot scale improved from 77.6 ± 2.6 points preoperatively to 97.2 ± 5.2 points postoperatively (p < 0.01).
Arthroscopic excision of separated ossicles of the lateral malleolus achieved good results with minimum incisions, and relatively early resumption of daily and sports activity was possible. However, when the ossicles were embedded within the fibers of the anterior talofibular ligament, it was impossible to avoid cutting of ligament fibers. To reduce the possibility of ligament dysfunction, we believe postoperative treatment should conform to the accepted method for treatment of acute ankle sprains.
Fracture - dislocations of the talus are typically due to high energy injuries. Displaced fracture - dislocations of the talus have poor outcomes in general and complications are common. Although talar fracture is common and comprises the second most common tarsal fracture, bilateral fracture - dislocations of the talus are rare. Not many reports regarding the subject can be found in the literature.
We report a patient with bilateral fracture - dislocations of the talus treated by open reduction and internal fixation. This patient was a 25 year-old man who sustained bilateral fracture - dislocation of the talus due to a motor vehicle accident.
Bilateral talar fracture - dislocation is rare. The surgical approach discussed together with the pathomechanics of this injury can yield good short term results.
Dislocation; Talus; Fracture Fixation, Internal
Adhesive tape is often used to help athletes recover from ligament sprains of the ankle or to prevent further injury. The choice of taping technique or material is often decided by personal preference, superstition, or anecdote. More recently, the use of ankle braces has become more prevalent, but reasons for their use are similarly variable. As ankle sprains are a major cause of an athlete's disability and time off sport, the choice of the method of support should be more scientifically reasoned. This paper attempts to review the literature concerning the effects of various methods of ankle support on swelling, stability, range of movement, proprioception, muscle function, gait, and performance tests. There is still some contradiction in the literature about the effects of taping and braces in both the acute and chronic phases of ligament sprains of the ankle.
Displaced talar neck and body fractures are rare and serious injuries with important outcomes. The aim of our study was to evaluate the long-term outcomes of these fractures after operative treatment in our centre between 1993 and 2005. Displaced talar fractures have a high rate of long-term complications. This was a retrospective study concerning 20 patients with an average follow-up of 7.5 years. The final follow-up examination included determination of the AHS score (ankle–hindfoot scale) from the American Orthopaedic Foot and Ankle Society (AOFAS), range of motion evaluation and radiological analysis. Mean age at the time of trauma was 38.8 years. This study comprised ten talar neck fractures and ten talar body fractures. We always used a single surgical approach and obtained anatomical reduction in 30% of the whole series of both groups. Four early complications were noted in four patients (20%). We noted no skin complications and the rate of consolidation was 100%. Four patients (20%) developed avascular necrosis of the talus, and at final follow-up seven patients (35%) had undergone secondary surgery. Radiographic analysis showed an osteoarthritis rate of 94% and a malunion rate of 59%. The mean AOFAS score was 66.9/100 and range of motion was systematically decreased. Contrary to undisplaced talar fractures, displaced talar fractures are a therapeutic challenge with many early or late complications. The outcome often revealed stiffness and osteoarthritis.
Fractures of the talar body present a great challenge to surgeons due to their rarity and high incidence of sequelae. This study reports the medium-term results of displaced fractures of the talar body treated by internal fixation. Nineteen patients (13 M, 6 F, mean age 31) with talar body fractures were studied retrospectively to assess outcome after operative treatment. The fractures were classified as coronal (11), sagittal (6) and crush fractures (2). Six patients sustained open fractures and two had associated talar neck fractures. Average follow-up was 26 months (range: 18–43). Clinical outcome based on American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring was excellent function in four patients, good in six, fair in four and poor in five. Early complications included two superficial wound infections, one partial wound dehiscence, one instance of skin necrosis and one deep infection. Other complications included delayed union in one, avascular necrosis in seven and malunion in one patient. Talar injuries are serious because they can compromise motion of the foot and ankle and result in severe disability. Crush fractures of the talar body and those associated with open injuries and talar neck fractures are associated with a less favourable outcome.