Talar Avulsion Fracture
Those with radiographically apparent avulsion fractures or other minor talus fracutres should be placed in a post-mold splint with the foot in neutral position and made non-weight-bearing, with referral to an orthopedist for further management. Most heal well with supportive care, but some (especially those with avulsed fragments >5 mm in size) will require elective excision. The main complication of talar fracture is arthritis, which is uncommon with avulsion fractures.
Patients with normal radiographs but exam findings concerning for occult fractures should be managed as avulsion fractures, with CT/MRI performed as outpatients if pain persists at the time of orthopedic evaluation. Those with high-energy mechanisms concerning for major body or neck fractures (axial loading or forced hyperdorsiflexion, respectively) require orthopedic consultation and CT while in the ED.