The talar dome is the top of the talus bone in the foot, which articulates with the ankle. Talar dome injury generally occurs due to significant or recurrent ankle sprain or fracture, often associated with participation in sports and activities involving high impact and pivoting. The injury involves damage to the cartilage and/or underlying bone and the degree of injury can vary considerably.
Symptoms include:
- Deep ankle pain – usually in the front of the joint.
- Stiffness and loss of ankle mobility.
- Occasionally clicking, catching, or locking.
- Increased pain with impact, prolonged weight bearing and change of direction.
Diagnosis
Talar dome injury is often diagnosed by your physio, based on history of injury, your symptoms, and assessment of ankle mechanics. With suspicion of a more significant injury, MRI is often used to assess the degree of damage, particularly bony involvement and assist in guiding the degree of initial support and offloading required.
Treatment
Initial management offloads the ankle to decrease pain and inflammation and allow any injury to the cartilage and/or bone to heal. Depending on the severity of the injury, you may need to strap the ankle, immobilise in a boot and or use crutches. Occasionally, surgery to remove unstable cartilage or bony fragments may be required.
The vast majority of talar dome injuries can be managed conservatively. After an appropriate period of offload, a graded rehab program may commence, involving manual therapy to restore full ankle mobility, exercises focusing on restoring strength, balance and neuromuscular control with progressively heavier and more complex movements.
Why is Early Management Important?
Articular cartilage doesn’t heal well, as a result early immobilisation gives the best chance for the cartilage and other bony injury to heal. Delayed immobilisation may result in poor healing and worse long-term outcomes. It is important to note that untreated talar dome injuries may also contribute to early-stage osteoarthritis, as 78% of ankle osteoarthritis cases are post-traumatic.
If you’re experiencing symptoms of talar dome injury, book in today to see an experienced physio for accurate diagnosis and treatment plan. Working together, we can get you moving and back to the activity you love and prevent long term complications.
Article by Jim Burke
