talus chip fracture

[upthecreek]

Hi
I'm a 44yr old female with reduced mobility due to chronic lumbar back pain ( Areas L2 -S1, 3 degenerative discs, 3 X Facet joint arthopathy, end plate changes, unilateral pars defect L5 with large osteophyte, Mild spondlolisthesis L4 ) I'm advised that I have absent achilles reflexes. Although I have no neuro defecit I have recently fallen four times - I suspect because my balance is altered and my focus is on avoiding pain. The last time I fell I managed to severely sprain my left ankle. I heard a snapping noise at the time and was unable to weight bear. Despite RICE overnight the swelling and bruising were severe and extensive and I was still unable to weight bear the next day so went to A&E. Xray showed a small chip fracture of the talus (don't know which area) and the extremely busy reg said it was small and I should treat it like a ligament rupture , NWB 48hrs then WB with crutches and get physio. I've done so, attended an excellent sports physio weekly for the last 3 weeks and am able to walk on it. After the initial very severe pain it became virtually pain free which didn't tally with how it looked.Can anyone reassure me that conservative treatment is appropriate for this injury please? It is still swollen and feels like deep toothache (although I'm on 240g of codeine daily for my back ). Thanks for any info.

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[physiobob]

Myself I would have had you on non-weight bearing for a lot longer time but then that delends on where the chip was. The fact that the pain has resolved steadily indicates that this approach seems appropriate. Remember you have a fracture, and perhaps a fracture on a weight-bearing surface which will take some time to heal. I would expect some 'tooth ache' sensation for 2-3 months. Sounds like you're in good hands

As for swelling, that will be around for 12-18 months if not longer. Often the appearance of a swollen ankle remains forever following a good sprain!

[upthecreek]

Thanks for your quick response and reassurance. Just to clarify -at the time of injury the pain was intense but resolved to very mild within 24 hours (at rest). Now (3 weeks later and having stopped seeing my physio) I have started getting the increasing 'tooth ache' feeling. I suspect that it is because I'm walking for longer periods. My physio thought that one of the ligaments ( sorry don't know which one) was probably completely ruptured with damage to other ligaments as well. The swelling seems to be in two distinct areas, one about 4 inches above the ankle and the other in front of the ankle in what seems to me to be a more normal place. Should I just continue with the exercises I've been given or revisit my physio? Sorry to add on to my previous query!

[physiobob]

Best to revisit and not do anything that makes it worse. A bit of discomfort is OK, but not a continued increase in symptoms.

[upthecreek]

Thanks again for your info and advice - much appreciated