Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. This is called, Your surgeon then uses tools such as metal plates, screws or wires to connect your ankle's broken pieces. When you have a trimalleolar fracture, you've broken three bony sections at the end of your lower leg bones: The bony sections, which are sometimes called the malleo complex, create a three-sided frame supporting the ligaments that keep your ankle stable and let you move your ankle and foot. (Even then, your ankle might feel wobbly or unstable because your ligaments and tendons take more time to heal than your bones.). The talus often breaks in the mid-portion or "neck" of the bone. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. With unstable talus fractures, the blood supply to the bone can be disrupted at the time of the injury. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all tissues); As the individual transfers weight from the heel to the metatarsus, the foot will not roll far enough in a medial direction. Be sure to talk to your healthcare provider before putting weight on your injured ankle. You'll need help with personal care such as meals, moving to and from your bed, using the bathroom and bathing. [2], The forefoot is composed of five toes and the corresponding five proximal long bones forming the metatarsus. The current inch and foot are implied from measurements in 12c. Stable, well-aligned fractures, however, can often be treated without surgery. [6], Extensor group: the tibialis anterior originates on the proximal half of the tibia and the interosseous membrane and is inserted near the tarsometatarsal joint of the first digit. Treatment and prognosis An overpronator does not absorb shock efficiently. bone grafting rarely needed, stiffness may be an early sign of a non-union or delayed union, by 24 weeks 90% of motion returns and full motion is present by 48 weeks, fracture that does not heal with 6 weeks of immobilization, fracture that is seen more than 2 weeks after injury, may be treated with immobilization if minimally displaced, must be followed until radiographic union as nonunion is common in this scenario, higher rate of nonunion than other elbow fractures, constant motion at fracture site from pull of the wrist extensors, intra-articular (synovial fluid impede fracture healing), poor metaphyseal circulation to distal fragment, preserving soft tissue attachments to lateral condyle, goal is to obtain union of metaphyseal fragment, not restore joint surface, due to lateral physeal arrest or more commonly a nonunion, slow, progressive ulnar nerve palsy caused by stretch, significant deformities that cause physeal arrest, supracondylar osteotomy after skeletal maturity and ulnar nerve transposition, posterior dissection can result in lateral condyle osteonecrosis, area between medial ossification center and lateral condyle ossification center resorbs or fails to develop, up to 50% regardless of treatment, families should be counseled in advance, result of displacement of the metaphyseal fragment in addition to disruption of the periosteal envelope, lateral periosteal realignment will prevent this from occurring, spurring is correlated with greater initial fracture displacement, young patients may be treated with bar resection or osteotomy, older patients best treated with completion of the epiphysiodesis and osteotomy, Unsatisfactory appearance of surgical scar, Outcomes have historically been worse than supracondylar fractures, Associated posteromedial elbow dislocations, final ROM similar to isolated lateral condyle fracture. The splint should extend from the toe to the upper calf. This leaves humans more vulnerable to medical problems that are caused by poor leg and foot alignments. Stop taking Viagra or other medications for erectile dysfunction for at least 24 hours before the procedure. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. This arch stretches from the heel bone over the "keystone" ankle bone to the three medial metatarsals. Compared to most other bones, the talus is deficient in its supply of oxygenated blood. The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or gluteal region. Other examples of bone injuries include stress fractures, osteochondral fractures and a variety of different patterns of bone fractures. All rights reserved. Together, the talus and calcaneus form the subtalar joint. Current radiographic evaluation of the patients elbow will most likely reveal what deformity? As the individual transfers weight from the heel to the metatarsus, however, the foot will roll too far in a medial direction, such that the weight is distributed unevenly across the metatarsus, with excessive weight borne on the hallux. Many talus fractures require surgery because of the high-energy force that creates the injury. Treatment may be nonoperative or operative depending on the degree of articular displacement. The inside support area is marked by strong greyish material to support the weight when a person lands on the outside foot and then roll onto the inside foot. Your ankle is a joint where the talus bone of the foot and the tibia (shin bone) and fibula of the leg connect and move. During the gait cycle the foot can pronate in many different ways based on rearfoot and forefoot function. Lateral spurring is common in patients treated surgically because of surgical disruption of the overlying periosteum. [edit | edit source]A bone bruise is a type of bone injury. Ankle Fracture Symptoms and Causes . In this stage of the gait, the knee will generally, but not always, track inward. What is the most appropriate course of action? This type of fracture often occurs during a high-energy event, such as a car collision or a fall from a significant height. Closed reduction of elbow and immobilization in cast for 6 weeks, ORIF with repair of the LCL to the lateral condyle, ORIF with repair of the LCL to the supinator crest, Open reduction with percutaneous fixation or internal fixation, Closed reduction and percutaneous pinning of the lateral condyle. This is a natural part of the healing process. Often absent, the opponens digiti minimi originates near the cuboid bone and is inserted on the fifth metatarsal bone. It provides connections among the bones of the feet. Studies have shown[3] that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbidities. Physical therapy is an essential part of recovering from a trimalleolar fracture. The trauma is sometimes accompanied by ligament damage and dislocation.[4]. The adductor hallucis is part of this group, though it originally formed a separate system (see Contrahens). Elevating the foot above the level of the heart helps to minimize swelling and pain. X-ray avulsion fracture of the summit of the left lateral malleolus. You will be in a cast or brace for several weeks after surgery. Trimalleolar fractures require surgery and extensive physical therapy. Open fracture:When broken bones break through the skin, the injury is called an open or compound fracture. Acute management of trimalleolar fracture. Healthline Media does not provide medical advice, diagnosis, or treatment. Tell your healthcare provider how you are feeling. This is your posterior malleolus. Younger people are injured playing sports, being in motor vehicle accidents or falling. Image showing the lateral malleolus as part of the fibula. The final range of motion of the elbow is not influenced by the size of the lateral spur. An anthropometric study of 1197 North American adult Caucasian males (mean age 35.5 years) found that a man's foot length was 26.3cm with a standard deviation of 1.2cm.[3]. The trimalleolar fracture is also known as cotton fracture. Immobilization in a long arm cast for 3 weeks, Immobilization in a long arm cast for 8 weeks, Open reduction and immobilization in a long-arm cast for 3 weeks, Open reduction and internal fixation with smooth pins or cannulated screw, Open reduction and internal fixation with plate and screw construct, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Paediatric Lateral Condyle Humerus Fixation, Percutaneous Fixation of Lateral Condyle Fracture. Minimally displaced or stable fractures:This type of fracture is barely out of place. Show signs of infection such as fever, chills, drainage from your surgical wound or it hurts to touch your wound. Spinal fractures are usually the result of significant trauma to a normally formed skeleton or the result of trauma to a weakened spinal column. Top Many doctors encourage motion of the foot and ankle early in the recovery period, as soon as your pain allows. The major structure that passes anterior to the medial malleolus is the saphenous vein. Type 1 talus fractures have a clear vertical fracture line, but very little, if any, separation of the two parts of the talus and it remains in the proper anatomical position within the ankle. Both these muscles are inserted with two heads proximally and distally to the first metatarsophalangeal joint. As your break heals and your pain improves, you will be allowed to put more pressure on your foot. The foot can be subdivided into the hindfoot, the midfoot, and the forefoot: The hindfoot is composed of the talus (or ankle bone) and the calcaneus (or heel bone). You should seek immediate healthcare if you: Trimalleolar fractures are complicated and serious injuries. In the foot, there are three cuneiform bones. The talus bone sits between the bones of the lower leg and the calcaneus (heel bone). Sometimes, the blood supply simply returns to the bone and normal healing begins. AP radiographs are taken on the date of injury and at 6 weeks postoperatively, shown in Figures A and B respectively. AP radiographs are taken on the date of injury and at 6 weeks postoperatively, shown in Figures A and B respectively. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.. Ankle fractures may result from excessive stress on the joint such as from She is able to cross her fingers without difficulty. (OBQ11.192) These tendons divide before their insertions and the tendons of flexor digitorum longus pass through these divisions. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Practical points Patients who have had surgery are instructed to begin moving the affected area as soon as the wound heals. You could be in a cast or brace for up to six weeks. On physical examination, she has full, but painful range of motion of her elbow. Radiographs are demonstrated in figures A-C. What is the optimal definitive treatment for this injury? Due to their position and function, feet are exposed to a variety of potential infections and injuries, including athlete's foot, bunions, ingrown toenails, Morton's neuroma, plantar fasciitis, plantar warts, and stress fractures. The plantar interossei adduct and the dorsal interossei abduct these digits, and are also plantar flexors at the metatarsophalangeal joints.[14]. Coming to a Cleveland Clinic location?Cole Eye entrance closingVisitation, mask requirements and COVID-19 information. The key function of this bone is to form a connection between the leg and the foot so that body weight may be transferred from the ankle to the leg, enabling a person to walk while maintaining balance. This article incorporates text in the public domain from page 5 ofthe 20th edition of Gray's Anatomy (1918).mw-parser-output .reflist{font-size:90%;margin-bottom:0.5em;list-style-type:decimal}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}, This article is about the structure in human anatomy. It could be six weeks before you can put weight on your injured ankle or walk using your injured ankle. Stead TS, Pomerantz LH, Ganti L, Leon L, Elbadri S. It has two heads, the oblique head originating obliquely across the central part of the midfoot, and the transverse head originating near the metatarsophalangeal joints of digits five to three. All material on this website is protected by copyright. Surfaces. They form the subtalar joint. Copyright 2022 Lineage Medical, Inc. All rights reserved. The metatarsals are the bones that make up the main part of the foot in humans, and part of the leg in large animals or paw in smaller animals. An individual whose bone structure involves internal rotation at the hip, knee, or ankle will be more likely to underpronate than one whose bone structure has external rotation or central alignment. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. It is usually visible. The quadratus plantae originates with two slips from the lateral and medial margins of the calcaneus and inserts into the lateral margin of the flexor digitorum tendon. The expression "to put one's best foot foremost first recorded 1849 (Shakespeare has the better foot before, 1596)". Open reduction and internal fixation. In this stage of the gait, the knee will generally, but not always, track laterally of the hallux. In anatomy, pronation is a rotational movement of the forearm (at the radioulnar joint) or foot (at the subtalar and talocalcaneonavicular joints). Our website services, content, and products are for informational purposes only. [11] Similar to the intrinsic muscles of the hand, there are three groups of muscles in the sole of foot, those of the first and last digits, and a central group: Muscles of the big toe: the abductor hallucis stretches medially along the border of the sole, from the calcaneus to the first digit. Hindfoot is composed of 2 bones: calcaneus and talus. Anterior Drawer Test. Trauma here can cause a break in any or all of these bones and significant pain usually results immediately after the injury. Flexor digitorum brevis flexes the middle phalanges. A 6-year-old girl is referred for the elbow injury seen in Figure 2. Types of pronation include neutral pronation, underpronation (supination), and overpronation. The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis.It has a The neck is between the "body" of the talus, under the tibia, and the "head" of the talus, located further down the foot. A radiographic series is obtained and the fracture line is only appreciated on the internal oblique view. Most talus fractures are the result of high-energy trauma such as a car collision or a fall from height. You will have to wear a cast for 6 to 8 weeks. Brostrom repair with the InternalBrace procedure provides additional fixation of the repaired ligament back down to bone during the healing process, allowing early mobility during recovery and a quicker return to activity. The metatarsal bones of feet and paws are tightly grouped compared to, most notably, the human hand where the thumb metacarpal diverges from the rest of the metacarpus. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus.The trauma is sometimes accompanied by ligament damage and dislocation.. Trying to walk with a trimalleolar fracture would be very painful and might damage your ankle ligaments and tendons. This action strains the sturdy medial (deltoid) ligament of the ankle, often tearing off the medial malleolus due to its strong attachment. What is a bone bruise? It dorsiflexes the big toe and also acts on the ankle in the unstressed leg. Arising from the base of the fifth metatarsal, the flexor digiti minimi is inserted together with abductor on the first phalanx. They line up your ankle's broken pieces. The coronal alignment of her elbows in extension is symmetric. Episode 181: Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up Stress testing for Ligaments [edit | edit source] 1. After surgery, you will feel some pain. The femoral artery is one of the major arteries in the human body. These two muscles are the strongest pronators and aid in plantar flexion. When the cast is removed, your doctor will give you exercises to help restore range of motion and strengthen your foot and ankle. This is your medial malleolus. As a historical note, there are four methods of judicial hanging, and the process is more complicated than may be evident at first glance. Doing too much too soon might cause you to re-injure your ankle. The lateral malleolus is the prominence on the outer side of the ankle, formed by the lower end of the fibula. For the unit of measure, see, Deep and superficial layers of posterior leg muscles, Plantar aspects of foot, varying depths (superficial to deep), Tradition of removing shoes in the home and houses of worship, "Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies", "Rex Ryan's Apparent Foot Fetish Not Necessarily Unhealthy", https://en.wikipedia.org/w/index.php?title=Foot&oldid=1126521052, Short description is different from Wikidata, Wikipedia articles needing clarification from December 2020, Articles with unsourced statements from November 2013, Creative Commons Attribution-ShareAlike License 3.0. It is also known as the flexor accessorius. This rolling inward motion as the foot progresses from heel to toe is the way that the body naturally absorbs shock. Classification. Rotator Cuff and Shoulder Conditioning Program. With the cuboid serving as its keystone, it redistributes part of the weight to the calcaneus and the distal end of the fifth metatarsal. Trimalleolar fractures are the least common ankle fracture. Get useful, helpful and relevant health + wellness information. Pathology. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. You might walk with a limp even after your fracture heals. [8], The superficial layer of posterior leg muscles is formed by the triceps surae and the plantaris. [1] The expression to "put one's foot in (one's) mouth "say something stupid" was first used in 1942. Treatment includes no weight bearing in a cast. Classification. Walking with a limp for a few months after your surgery. The bone also helps in the movements of the ankle, and together with the calcaneus it facilitates the movements of the foot. Radiopaedia.org, the wiki-based collaborative Radiology resource An 8-year-old boy falls on his right upper extremity and presents to the emergency room with the radiographs shown in Figures A and B. This website also contains material copyrighted by third parties. The more severe the talus fracture, the more likely it is that AVN will occur. This page was last edited on 9 December 2022, at 20:16. "[1], The human foot is a strong and complex mechanical structure containing 26 bones, 33 joints (20 of which are actively articulated), and more than a hundred muscles, tendons, and ligaments. J Am Acad Orthop Surg 2001; 9:114-127. from the American Academy of Orthopaedic Surgeons, Inability to walk or bear weight on the foot, Considerable swelling, bruising, and tenderness. Most commonly, the talus breaks in its mid-portion, called the "neck." There are a number of contexts where it is considered inappropriate to wear shoes. Which of the following statements is true? After reviewing your symptoms and medical history, your doctor will do a careful examination. On plain film, dorsal avulsion injuries are best detected on a lateral projection, where typically an avulsed flake of bone is identified lying posteriorly to the triquetral bone (see pooping duck sign). What is the most appropriate treatment? As soon as your pain begins to improve, stop taking opioids. The plantaris originates on the femur proximal to the lateral head of the gastrocnemius and its long tendon is embedded medially into the Achilles tendon. Displaced fracture. [13], Central muscle group: The four lumbricals arise on the medial side of the tendons of flexor digitorum longus and are inserted on the medial margins of the proximal phalanges. This is the smaller bone in your lower leg. They'll be able to recommend programs to help you manage your recovery. When the bone collapses, the articular cartilage covering the bone is also damaged. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. You'll have a cast or brace that will keep you out of the driver's seat until the cast is removed or you don't need the brace. If you take certain (but not all) blood pressure medications, talk to your healthcare provider about taking your medication with a sip of water. An ankle fracture is a break of one or more of the bones that make up the ankle joint. The distal end of the tibia is much smaller than the proximal end and presents five surfaces; it is prolonged downward on its medial side as a strong pyramidal process, the medial malleolus.The lower extremity of the tibia together with the fibula and talus forms the ankle joint.. ", https://en.wikipedia.org/w/index.php?title=Malleolus&oldid=1109197284, Wikipedia articles incorporating text from the 20th edition of Gray's Anatomy (1918), Short description is different from Wikidata, Articles needing additional references from April 2012, All articles needing additional references, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 8 September 2022, at 14:34. They often require surgery to restore the alignment and give the best chance for a return to normal function of the foot and ankle. When a fracture is not seen but there is clinical suspicion, a Coyle's view can be performed (see elbow radiography). Strictly speaking, there are only two malleoli (medial and lateral), but the term trimalleolar is used nevertheless and as such is a misnomer. [1] The expression "put (one's) foot in something" meaning to "make a mess of it" was used in 1823. Imagine someone jumping onto a diving board, but the board is so flimsy that when it is struck, it bends and allows the person to plunge straight down into the water instead of back into the air. [1], The word "footloose" was first used in the 1690s, meaning "free to move the feet, unshackled"; the more "figurative sense of "free to act as one pleases" was first used in 1873. [12], Muscles of the little toe: Stretching laterally from the calcaneus to the proximal phalanx of the fifth digit, the abductor digiti minimi form the lateral margin of the foot and are the largest of the muscles of the fifth digit. You might become frustrated, anxious or feel depressed as you wait for your ankle to heal. A trimalleolar fracture happens when you break your lower leg sections that form your ankle joint and help you move your foot and ankle. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. When choosing a running or walking shoe, a person with overpronation can choose shoes that have good inside supportusually by strong material at the inside sole and arch of the shoe. 17% of all distal humerus fractures in the pediatric population, typically occurs in patients aged 6 years, avulsion fracture of the lateral condyle that results from the pull of the common extensor musculature, fall onto an outstretched hand causes impaction of the radial head into the lateral condyle causing fracture, fractures originate proximally at the posterior aspect of the distal humerus metaphysis and extend distally and anteriorly across the physis and epiphysis into the elbow joint, fracture may extend medially into the trochlear groove, making the elbow unstable and prone to dislocation, result of FOOSH with slight elbow flexion and adduction force, the brachial artery lies anteriorly in the antecubital fossa, most of the blood supply of the distal humerus comes from the anastomotic vessels that course posteriorly, remains intact and attached to lateral condyle fragment proximally and radial neck distally, Fracture line is lateral to trochlear groove (less common, elbow is stable as fracture does NOT enter trochlear groove), Fracture line extends medially into trochlear groove (more common, more unstable), Fracture Displacement Classification- Weiss et al, < 2mm, indicating intact cartilaginous hinge, > 2 mm < 4 displacement, intact articular cartilage on arthrogram, > 4 mm, articular surface disrupted on arthrogram, may be subtle if fracture is minimally displaced, exam lacks the obvious deformity often seen with supracondylar fractures, swelling and tenderness are usually limited to the lateral side, lateral ecchymosis implies a tear in the aponeurosis of the brachioradialis and signals an unstable fracture, may have increased pain with resisted wrist extension/flexion, contralateral elbow for comparison when ossification is not yet complete, routine elbow stress views are not recommended due to pain and lack of useful information, in displaced fractures, the capitellum is laterally displaced in relation to radial head, posteriorly based Thurston-Holland fragment on the lateral view, to assess cartilage surface when there is incomplete/absent epiphyseal ossification, rarely indicated, only if there is uncertainty as to the type of fracture, provides the ability to assess the cartilaginous integrity of the trochlea, useful for operative planning of delayed or non-unions, medial cartilaginous hinge must remain intact, cast with elbow at approx 90 degrees as long as swelling is mild, weekly follow up and radiographs every week x first 3 weeks, including internal oblique view, occasionally > 6 weeks of casting is needed, 2 - 4 mm of displacement have intact articular cartilage and can be treated with CRPP, open reduction (rather than closed) necessary to align the joint surface, deformity correction in late-presenting cubitus valgus - rarely needed, closed reduction perhaps aided by pushing the fragment anteromedially to close the gap, screw may need to be removed if crossing the physis, anterolateral approach as blood supply comes from posteriorly, below the skin, dissection to the joint is most often already accomplished by injury, avoid dissection of the posterior aspect of lateral condyle (source of vascularization), directly visualize the joint reduction, at times the metaphyseal reduction may not be perfect, as fracture fragment may have plastic deformation, most fractures can be fixed with 2 percutaneous pins (3 if comminuted) in parallel or divergent fashion, single screw for large fragments or non-union. In the non-weight-bearing leg, the tibialis anterior dorsiflexes the foot and lift its medial edge (supination). Reproduced and modified with permission from Fortin PT, Balazsy JE: Talus fractures: evaluation and treatment. The midfoot is connected to the hind- and fore-foot by muscles and the plantar fascia. Non-surgical treatment may sometimes be considered in cases where the patient has significant health problems or where the risk of surgery may be too great. Injury to the medial ankle may even lead to fracture of the medial malleolus without a significant sprain to the deltoid ligament. You might need more than one surgery to repair each broken bone. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, (https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/), (https://radiopaedia.org/articles/trimalleolar-fracture?lang=us). Below its tendon, the tendons of the long flexors pass through the tarsal canal. But it usually takes four to six months before their injured ankle is strong enough to do that without re-injuring their ankle. During walking it not only lifts the heel, but also flexes the knee, assisted by the plantaris. Avascular necrosis of the lateral fragment, Fracture nonunion and a normal carrying angle. Its precise location is within the sole of the foot, directly above the plantar aponeurosis, The dorsal calcaneocuboid ligament is part of a group of muscular fibers in the foot. Epidemiology. On the top of the foot, the tendons of extensor digitorum brevis and extensor hallucis brevis lie deep in the system of long extrinsic extensor tendons. The flexor hallucis longus arises on the back of the fibula on the lateral side, and its relatively thick muscle belly extends distally down to the flexor retinaculum where it passes over to the medial side to stretch across the sole to the distal phalanx of the first digit. Last medically reviewed on April 14, 2015. This information is provided as an educational service and is not intended to serve as medical advice. [4], The human foot has two longitudinal arches and a transverse arch maintained by the interlocking shapes of the foot bones, strong ligaments, and pulling muscles during activity. Injuries from sports, particularly snowboarding, are another, though less common, cause of talus injuries. Resists posterior displacement of the talus. Most trimalleolar fractures are treated with Open Reduction Internal Fixation (ORIF) surgery. Avoid eating and drinking for eight hours before you go to the hospital unless directed otherwise. "[1] (SBQ13PE.4) This illustration shows a displaced talus neck fracture. The triceps surae is the primary plantar flexor. Structures that pass behind medial malleolus deep to the flexor retinaculum: The lateral malleolus is found at the foot end of the fibula, of a pyramidal form, and somewhat flattened from side to side; it descends to a lower level than the medial malleolus. A trimalleolar fracture affects your quality of life, as you will need help with day-to-day activities until you can put weight on your ankle. The treatment is immobilization in a cast. This is your lateral malleolus. You might be taking medication for pain that could affect your ability to work. Arthroscopic or open trimming of the lateral spur is recommended to prevent late cubitus varus tarda. A cast will hold the bones in your foot in place while they heal. You can rate this topic again in 12 months. The slight mobility of these arches when weight is applied to and removed from the foot makes walking and running more economical in terms of energy. The majority of talus fractures result in some degree of posttraumatic arthritis. Like an overpronator, an underpronator does not absorb shock efficiently but for the opposite reason. 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