Anatomy

and
Clinical Importance
of
Talus

Presenter:
Dr. Pukar Rana
1st year resident
MS Ortho, NAMS
➢Second largest tarsal bone

➢Also called ASTRAGALUS

➢From Latin, literally ‘ankle, heel’

➢The tarsal homologue of the carpal

lunate

➢Forms hindfoot (along with

calcaneum)
➢Links foot and leg

➢Lies between tibia above,

calcaneum below and two
malleoli in two sides

➢Only bone through which

the entire body weight load
is channeled, before being
distributed to the arches of
the foot

➢The cornerstone of the

medial longitudinal arch of
the foot
• Peculiarities:
▫ its external surface is 60% articular cartilage and
▫ it has no muscular attachments

• Articulations:
▫ i. Ankle joint
▫ ii. Subtalar joint
▫ iii. Talocalcaneonavicular joint
• Three Parts:-
1. Head
2. Neck
3. Body

Fig. Parts of talus and relations with

calacaneum
 Head
➢Directed forward, downward
and medially

➢The anterior surface is oval

and convex, articulates with
posterior surface of navicular

➢The long axis of the head is

rotated 45° medially; this
angle is reduced in pes planus.
The inferior surface has three
articular areas separated by
indistinct ridges.
Head contd..

•Posterior facet is the largest, oval

and gently convex. Articulates with
middle facet of calcaneum

•Antero-lateral facet articulates

with the anterior facet of
calcaneum

•The medial facet with the spring

ligament
➢The constricted part between the head
and the body

➢Long axis is directed downwards, Neck

forwards and medially

➢Neck body angle is 130- 140 degrees in

children and 150 degrees in adults

➢This angle is reduced in pes planus (flat

foot).
➢The plantar surface has deep groove called sulcus tali

➢When the talus and calcaneus are articulated, forms a roof to

the sinus tarsi, which is occupied by interosseous
talocalcaneal and cervical ligaments
Body is cuboidal in shape and Body
has five surfaces, namely
superior, inferior, medial,
lateral and posterior.

➢ Superior surface: It is
also called trochlea ,
articulates with lower end
of tibia to form the ankle
joint.
 Body contd…

➢ Inferior surface: oval,

concave articular
surface. Articulates
with posterior facet of
calcaneum to form
sub-talar joint.
➢Medial surface:
articular above and non-
articular below. The
articular surface is coma
shaped and articulates
with medial malleolus.
➢Lateral surface:

Triangular articular
surface for articulation
with lateral malleolus

It has a mean vertical

concavity of 115°; this
angle is increased in
pes planus, and
reduced in pes cavus
➢Posterior surface:
`
No articulation

Has oblique groove bounded

by medial and lateral
tubercles, FHL tendon passes
through it.

Posterior tubercle is also

present. When occassionly
separate , it is called os-
trigonum.
1- facet for tibial
malleolus
2- medial (deltoid)
ligament, deep
component
3- entrance to sinus tarsi
4- posterior annular
ligament (roof of the
canal of the flexor
hallucis longus tendon)
5- superficial component
of medial ligament
attached to talar neck Fig. Medial Aspect of talus
1- facet for fibular
malleolus
2- anterior talofibular
ligament
3- posterior talofibular
ligament
4- lateral talocalcaneal
ligament
5- entrance to sinus
tarsi
6- cervical ligament
Fig. Lateral aspect of the
talus –
angle of inclination of the
neck
1- facet for navicular
bone
2- facet for spring
ligament
3- anterior talofibular
ligament
4- cervical ligament
5- anterior tibiotalar
fibres of medial
Fig. Anterior aspect of the
ligament talus –
angle of head rotation
1- trochlea with inclined
lateral edge
2- facet for fibular
malleolus
3- posterior talocalcaneal
ligament
4- tendon of flexor hallucis
longus between the two
bundles of the annular
ligament
5- posterior fibres of
tibiotalar portion of
medial ligament
6- posterior portion of
talofibular ligament
Fig. Posterior Aspect of Talus
 Attachments
➢No muscular attachments.

➢Plenty of ligamentous attachments.

Dorsal surface distal part:

✓ capsular ligament of the ankle joint(4)
✓ dorsal talo-navicular ligament(3)

Inferior surface:
✓interosseous talo-calcaneal and cervical
ligaments(2)
✓posterior talocalcaneal ligament(8)
Lateral surface :
✓ anterior talofibular ligament(2)
✓ posterior talofibular ligament(3)
✓ lateral talocalcaneal ligament(4)
✓ cervical ligament(6)

Medial surface:
✓ posterior annular ligament (roof
of the canal of the FHL tendon)(4)
✓superficial component of deltoid
ligament attached to talar neck(5)
Posterior surface:
✓posterior talo-calcaneal
ligament(3)
✓tendon of flexor hallucis
longus between the two bundles
of the annular ligament(4)
✓ posterior fibres of tibiotalar
portion of medial ligament(5)
✓ posterior portion of talofibular
ligament(6)
Blood supply of talus
➢The first comprehensive understanding of its blood supply
was provided by Wildenauer in 1950

➢Blood supply of talus is rather tenous due to lack of muscle

attachment. And 60% of surface is covered by articular
cartilage.

➢Although it has a rich blood supply, with

contributions from all three main arteries of the lower limb,
the limited access makes its blood supply particularly
vulnerable to injury
➢It comprises two major sources

• extra-osseous

• intra-osseous
Extraosseous Blood Supply
1. Posterior Tibial artery
a) Artery of the tarsal Canal- gives off a deltoid
branch
b) Calcaneal Branches

2. Anterior Tibial artery (dorsalis pedis artery)

a) Medial tarsal branches
b) Anterolateral malleolar artery-contributes to
artery of tarsal sinus
Extraosseous Blood Supply contd..
3. Peroneal Artery- contributes to the artery of
tarsal sinus
Intraosseous Supply
1. Talar Head
a) Superomedial half: From branches of anterior tibial
artery (dorsalis pedis artery)
b) Inferolateral half: Includes arteries of Tarsal ring
(artery of tarsal canal and artery of trarsal sinus)

2. Talar Body
From anastomosis between arteries of tarsal canal and
artery of tarsal sinus
Blood supply contd..
• Artery of tarsal tunnel that banches off posterior tibial
artery 1cm proximal to division into medial and lateral
plantar arteries is the most consistent blood supplier to
talus

• Deltoid artery second major supplier. Supplies medial

one fourth to half of talar body

• Artery of tarsal sinus supplies lateral one eighth to one

fourth of talar body
Innervation:
Talus is innervated by branches of Deep peroneal , Posterior tibial ,
Saphenous and Sural nerves.

Ossification:
• Single ossification centre prenatally at 6 months
•The posterior process is a separate bone in 5% of individuals and
arises from a separate ossification centre, which appears between 8
and 11 years. (os trigonum) In athletes and dancers, it can cause
impingement against the posterior tibia, producing pain and
sometimes requiring surgical removal.
•Another more rare accessory bone is the os supratalare, which lies
on the dorsal aspect of the talus; it rarely measures more than 4 mm
in length.
BIOMECHANICS
Trabecular Patterns
• On the fact that when the foot is in weight-
bearing contact with the ground, there is a
medial sagittal arch, a major posterior support
on the calcaneus, as well as lateral support, with
an anterior transverse arch.
• Fractures of the body of the talus and of the
calcaneus, and talar neck fractures, occur along
vertical lines.
P.: body weight

R.: ground reaction

1- trabecular system of the

posterior calcaneus
2- trabecular system under
the attachment of the Achilles
tendon
3- plantar trabecular system
4- fracture line through body
of talus
5- fracture line through neck
of talus
6- posterior dislocation in the
subtalar joint resulting in
fracture of the posterior
malleolus
7- anterior dislocation of the Fig. Bony architecture of foot medial
talus view
AXIS OF THE ANKLE JOINT
• This axis slopes downwards, outwards, and backwards,
which accounts for the fact that the plane of dorsiflexion
and plantar flexion is angled 15° forwards and outwards
in relation to the sagittal plane.
MECHANICAL AXIS OF THE SUBTALAR
(TALOCALCANEAL) JOINT
• This axis affects also the mid-tarsal joint and, distally,
the joints of the forefoot. As described by Henke, it runs
from the craniomedial aspect of the talus to the lateral
tubercle of the posterior process of that bone.

Fig. Superior view of right foot -

mechanical axis of
talocalcaneal articulation (axis of Henke)
Injury to Talus:
• Significance of injuries enhanced by two facts:
1. Talus is major weightbearing structure (greatest
load per unit area)
2. Vulnerable blood supply and relatively common
site for post traumatic ischaemic necrosis
Talar Head Fractures
• Mechanism of injury: axial loading with ankle in
plantar flexion or compression of head of talus
against distal tibia in dorsiflexion
• Treatment:
1. Nondisplaced: short leg cast and no weight
bearing for 8-12 wks
2. Dislplaced: Excision, ORIF, Talonavicular
arthrodesis
Talar Neck Fractures
• Aviator’s astragalus
• Mechanism: Hyperdorsiflexon in which talus
impinges on distal tibia
 Talar Neck Fractures contd…
Hawkins and Canale classification of fracture neck of
talus

Type I: Nondisplaced
Type II: Displaced talar neck fracture and subluxation or
disloation of subtalar joint
Type III: Displaced talar neck fracture with dislocation of
both ankle and subtalar joints
Type IV: Displaced talar neck fracture with dislocation of
ankle and subtalar joints with talonavicular
dislocation
Talar Neck Fractures contd…

• Radiography: foot and ankle

series
• Canale view (Pronated
oblique view of midfoot to
better visualize the talar
neck. Ankle is in maximal
equinus, with foot pronated
15°. Direct the roentgen tube
75° from the horizontal)
 Talar Neck Fractures contd…
• Treatment (determined by Hawkins type)
1. Type I: 4-6 wks of nonweightbearing short leg
cast followed by 1-2 months in a walking cast
2. Type II: orthopedic emergency, Immediate
closed reduction and treatment as of type I; if
>5mm displacement or > 5 degrees- ORIF
3. Type III: same as type II, but ORIF more
common. Open injuries with contaminated
talus- excison with primary tibiocalcaneal or
Blair-type arthrodesis
4. Type IV: rare, same as Type II
Talar Neck Fractures contd…
• Complications
1. Skin necrosis and infections
2. Delayed union or nonunion
3. Malunion
4. Posttraumatic arthritis
5. Osteonecrosis: Hawkin’s sign, depends on type
⚫ Type I: up to 13%
⚫ Type II: 20% to 50%
⚫ Type III: virtually 100%
⚫ Type IV: virtually 100%
❑ Hawkin’s sign: subchondral radiolucency of talar
body after 8 weeks of talar neck #. It signifies the
vascular integrity and the # will unite
Talar Process Fractures
• Lateral Process Fractures
▫ Snow boarder’s fracture
▫ CT helpful
▫ Os trigonum either fused or separate with lateral
tubercle ( incidence 2.7% - 5.7% )
Talar Process Fractures contd..
• Treatment of lateral process fractures
a) Nondisplaced: Non weightbearing short leg cast
4 wks followed by weightbearing in short leg
cast for next 2 wks
b) Displaced: ORIF with small fragment fixation or
Herbert screw
c) Communited: Excision with early subtalar
motion with no weight bearing
Talar Process Fractures contd…
• Posterior Process Fractures (Shepherd's fractures)
▫ Hx of trauma and pain of insidious onset, pain
aggravated by forced equinus
▫ Hallux motion reproduces pain as FHL courses
adjacent to tubercles and through groove under
sustentaculum tali
• Mechanism (Two)
✓Hyperdorsiflexion and/or inversion leading to
tightening of posterior talofibular ligament with
avulsion of lateral tubercle
✓Forced plantarflexion causing compression of lateral
tubercle between tibia and calcaneus
Talar Process Fractures contd…
• Radiography: Lateral ankle view best
(acute fracture or discontinuity of os
trigonum). Bone scan

• Treatment of posterior process

fractures
▫ Nonweightbearing cast for 4 wks
followed by walking cast for 2 wks
▫ Symptoms lasting for 6 months:
Nonunion
▫ ORIF for nonunion via
postersolateral approach
Talipes Equinovarus (idiopathic clubfoot)
✓ In full blown equinovarus, heel is in equinus,
entire hindfoot in varus and the mid and forefoot
adducted and supinated
✓Could be due to germ defect or arrested
development
✓Neck of talus points downwards and deviates
medially whereas body is rotated slightly outwards
in relation to both calcaneum and ankle mortise
• Congenital vertical talus(congenital convex pes
valgus).

▫ Rare condition seen in infants

▫ Usually affects both feet.
▫ The hind foot is in equinus and valgus and the
talus points almost vertically towards the sole.
▫ The forefoot is abducted, pronated and dorsiflexed
with subluxation of talo-navicular joint.
▫ Correction is done by surgery.
• Atraumatic osteonecrosis of the talus

▫ Associated with the systemic disorders:

Hypercortisonism, alcoholism, SLE, Gaucher’s disease,
sickle-cell disease..
▫ Posterolateral part is almost always involved.
▫ Conservative treatment – surgical core
decompression- ankle arthodesis..
Osteochondritis
Dissecans of the talus

▫ Injury +, but there may not be history

▫ Unexplained pain and slight restriction of
movement of the ankle in a young adult
▫ Small bony separation at anteromedial or
posterolateral part of the superior surface of the
talus.
▫ Rx is Arthroscopic removal
References

• Gray’s Anatomy 39th edition

• Apley’s System of Orthopaedics and Fractures,

9th Edition

• Campbell’s Operative Orthopaedics, 12th Edition

• THANK YOU