What is a Tarsal Fracture?
A tarsal fracture refers to a break in one of the seven tarsal bones in the midfoot and rearfoot. These bones form the connection between the lower leg and the forefoot and are essential for foot stability and weight-bearing. Tarsal fractures can range from small cracks (stress fractures) to more severe, displaced breaks, often caused by trauma, falls, or twisting injuries.
Prompt diagnosis and treatment help reduce the risk of long-term issues such as instability, arthritis, or chronic pain.
What are the Types of Tarsal Fractures?
Tarsal fractures can affect any of the seven tarsal bones (click the links for specific details on each bone):
- Calcaneus (heel bone) – is often fractured by high-impact injuries like falls or car accidents.
- Talus – connects the foot to the ankle; fractures may occur in sports or high-energy trauma.
- Navicular – vulnerable to both stress and traumatic fractures.
- Cuboid – less common, usually from crush or twisting injuries.
- Medial, intermediate, and lateral cuneiforms – rare, usually from direct trauma or associated with midfoot injuries.
Fractures may be classified as stress (overuse-related) or acute (traumatic), and as non-displaced or displaced, depending on the severity and bone alignment.
How Common are Tarsal Fractures?
Tarsal fractures are less common than forefoot (toe) or ankle fractures, but still occur regularly, particularly in athletes, motor vehicle trauma, and falls from height. The calcaneus and talus are the most frequently fractured tarsal bones. Early recognition is crucial, as some tarsal fractures can be missed and may lead to complications if not treated promptly.
Symptoms and Causes
What are the Common Symptoms of Tarsal Fractures?
Symptoms of a tarsal fracture will be different depending on which of the tarsal bones are involved and the severity of the injury, but commonly include:
- Sudden pain in the midfoot, hindfoot, or heel after trauma
- Swelling and bruising in the foot or ankle
- Difficulty putting weight on the foot
- Tenderness to touch over the injured area
- A visible deformity in severe or displaced fractures
- Pain that worsens with activity (in stress fractures)
What Causes Tarsal Fractures?
Tarsal fractures typically result from:
- High-impact trauma, such as falls from height, motor vehicle accidents, or crush injuries
- Twisting or rolling injuries during sport or uneven ground contact
- Overuse or repetitive stress, especially in runners and military recruits (leading to stress fractures)
- Direct blows to the foot, such as dropping a heavy object on it
What are Tarsal Fracture Risk Factors?
The following risk factors may increase the likelihood of sustaining a tarsal fracture:
- High-impact or contact sports
- Falls from height or ladder
- Osteoporosis or low bone density
- Poor footwear or unsafe walking surfaces
- Repetitive loading (e.g. running long distances)
- Previous foot or ankle injury
- Certain medical conditions affecting bone strength
What are the Complications of Tarsal Fractures?
If not identified and managed appropriately, tarsal fractures can lead to:
- Chronic foot or ankle pain
- Post-traumatic arthritis
- Non-union or delayed healing
- Loss of foot stability or altered gait
- Nerve or tendon injury (in complex fractures)
- Increased risk of re-injury
Early diagnosis and appropriate orthopaedic care, such as that offered at Access Ortho, can significantly reduce the risk of long-term complications.
Diagnosis and Tests
How are Tarsal Fractures Diagnosed?
Tarsal fractures are diagnosed through a combination of history taking, clinical assessment and imaging. A healthcare provider will discuss how your injury occurred, examine the foot, check for tenderness, swelling, and deformity, and assess your ability to bear weight. Prompt and accurate diagnosis is crucial, as tarsal fractures are sometimes subtle and can be missed without appropriate imaging.
Which Tests do Providers Use to Diagnose Tarsal Fractures?
- X-rays are typically the first step and can identify most tarsal fractures.
- CT scans provide detailed images and are especially useful for complex fractures or those involving joints, such as the talus or calcaneus.
- MRI may be used to detect stress fractures or non-displaced fractures that don’t appear clearly on X-ray.
At Access Ortho, referrals for same-day imaging and expert assessment help ensure early diagnosis and efficient treatment.
Specific Considerations for Different Tarsal Fractures
Calcaneal (Heel Bone) Fractures
Calcaneal fractures are the most common tarsal fractures, usually caused by a fall from height. They may involve the subtalar joint and have the potential to lead to long-term complications if they are not managed properly. CT imaging is often needed for surgical planning.
Fractures of the talus can disrupt blood supply to the bone, increasing the risk of avascular necrosis (bone death). These are typically high-impact injuries and require close orthopaedic follow-up.
Navicular injuries may be stress-related in athletes or result from trauma. They often cause vague midfoot pain and may be hard to see on plain X-rays. CT or MRI is frequently needed.
Cuboid fractures can occur in crush injuries or with significant midfoot trauma. Displacement can affect foot stability and require orthopaedic evaluation to prevent long-term issues.
These are rare and often occur with other midfoot injuries. They may result from direct trauma or be seen in conjunction with Lisfranc injuries. Diagnosis may require advanced imaging to assess alignment and joint involvement.
Access Ortho Fracture Clinics in Brisbane (Indooroopilly) and Ipswich treat all talar fractures.
Management and Treatment
How are Tarsal Fractures Treated?
Treatment for tarsal fractures depends on the specific bone involved, the severity of the fracture, and whether the bone fragments are displaced. Management may be non-surgical or surgical, focusing on restoring foot function and preventing long-term complications.
Non-Surgical Treatment for Tarsal Fractures
Stable or non-displaced tarsal fractures can often be managed without surgery. This may include:
- Protective weight-bearing restrictions
- Use of a moon boot, cast, or brace
- Pain management and monitoring with follow-up imaging
- Physiotherapy once healing is underway
These approaches aim to allow the bone to heal naturally while maintaining alignment and preventing further injury.
Surgical Treatment Options for Tarsal Fractures
Surgery may be needed for:
- Displaced fractures
- Injuries involving joint surfaces
- Fractures that are unstable or at high risk of complications
Orthopaedic surgery may involve realigning the bone and securing it with plates, screws, or wires. The decision for surgery is made based on fracture type, patient activity level, and overall health.
Rehabilitation After Tarsal Fracture Treatment
Recovery involves a period of restricted activity, followed by graduated rehabilitation to restore strength, mobility, and balance. Weight-bearing is often reintroduced gradually under guidance. Physiotherapy plays a role in preventing stiffness, improving gait, and returning to daily activities or sport.
At Access Ortho, we provide timely diagnosis and ongoing orthopaedic support to optimise recovery and reduce complications.
Prevention
How Can I Prevent Tarsal Fractures?
Tarsal fractures are often caused by trauma, but the risk can be reduced by:
- Wearing supportive footwear, especially during sport or high-risk activities
- Improving balance and strength to prevent falls
- Using caution on uneven or slippery surfaces
- Avoiding overtraining in high-impact activities
Outlook / Prognosis
What Can I Expect if I Have a Tarsal Fracture?
Tarsal fractures can range from mild to complex. With early diagnosis and appropriate care, most fractures heal well. However, some may require a longer recovery, especially if the fracture involves a joint, is displaced, or affects weight-bearing bones. Ongoing follow-up is essential to monitor healing and prevent long-term issues such as stiffness, arthritis, or instability. The orthopaedic team at Access Ortho will guide you on expected recovery times.
What is the Recovery Time from a Tarsal Fracture?
Recovery time depends on which tarsal bone is fractured, the type of fracture, and whether surgery is needed. In general, most tarsal fractures require 6 to 12 weeks of limited weight-bearing and protection in a boot or cast. Full recovery may take several months. Physiotherapy may be recommended to assist with regaining mobility and strength.
Will I Need Surgery for My Tarsal Fracture?
Surgery is not always necessary. Many non-displaced or stable fractures can heal without an operation. However, displaced fractures, those involving joint surfaces, or fractures that do not heal with non-surgical treatment may require surgery to stabilise the foot and realign the bones.
The orthopaedic team at Access Ortho will discuss whether your injury needs surgical care. If surgery is recommended, the staff will assist with arranging a surgeon.
When Can I Return to Walking, Running, and Sports After a Tarsal Fracture?
Walking without support usually resumes after 6 to 12 weeks, depending on healing and clinical progress. Returning to running or high-impact sports typically takes longer and should be done gradually. This timeline varies depending on the type of fracture, whether surgery was required, and the individual’s overall recovery. Your orthopaedic team or physiotherapist will guide this process.
When Should I Go to a Fracture Clinic?
You should visit a fracture clinic if you have:
- Sustained a foot injury with immediate pain, swelling, or difficulty walking
- Fallen, rolled your ankle, or landed awkwardly and are unable to bear weight
- Have ongoing midfoot or hindfoot pain that isn’t improving after a few days
- Have been told you may have a foot fracture and need further assessment or imaging
Tarsal fractures are sometimes subtle and may be missed without proper investigation. Early diagnosis helps prevent long-term complications.
What is the Role Of Access Ortho in Treating Tarsal Fractures??
Access Ortho is a fracture clinic designed for rapid assessment and expert care of bone, joint, and soft tissue injuries. Our clinics are staffed full-time by experienced Orthopaedic and Emergency Nurse Practitioners, with orthopaedic surgeons available to review cases and conduct follow-up clinics each week.
For suspected tarsal fractures, we offer:
- Same-day assessment and referral for X-rays
- On-the-spot treatment plans, including moon boots, crutches, and pain management
- Specialist input from orthopaedic surgeons
- Ongoing fracture management, including imaging follow-up and return-to-activity planning
If you’ve had a recent injury and want peace of mind, Access Ortho provides efficient, specialist orthopaedic care, without waiting in a hospital emergency department.
Commonly Asked Questions About Tarsal Fractures
How do I know if I have a tarsal fracture or just a sprain?
Sprains or fractures can cause swelling and pain, but fractures are more likely to involve difficulty bearing weight, bony tenderness, or bruising. Imaging is often needed to tell the difference. Access Ortho offers rapid appointments and can provide referrals for, and immediate review of X-rays.
Can you walk with a tarsal fracture?
Some minor or stress fractures may still allow walking, but it is usually painful or limited. Walking on an undiagnosed fracture may worsen the injury. Once diagnosed, the medical team will advise you whether you can weight bear on the injury or need crutches.
How long will I need to wear a cast or boot for a tarsal fracture?
Most tarsal fractures require 6–8 weeks in a moon boot or cast, though this may vary depending on the bone involved and whether surgery was required. Follow your medical team’s advice.
Will I need crutches after tarsal fracture surgery?
Yes. Crutches are often needed for several weeks to protect the foot while it heals, particularly if weight-bearing is restricted. Your orthopaedic team will advise you on this.
What type of shoes should I wear after recovering from a tarsal fracture?
Supportive, cushioned shoes with a firm sole and good arch support are recommended. Avoid flat or unsupportive footwear during the early recovery phase.
How successful is surgery for tarsal fractures?
When needed, surgery can be highly effective. Success depends on fracture type, timing of treatment, and rehabilitation. Orthopaedic follow-up is key to long-term outcomes.
Will I develop arthritis after a tarsal fracture?
Some fractures involving joints, particularly of the talus or calcaneus, may increase the risk of post-traumatic arthritis. Early treatment and proper alignment reduce this risk.
When can I drive after tarsal fracture surgery?
Driving is usually safe once you can fully bear weight, react quickly, and are no longer using a boot or crutches. This often takes 6–12 weeks, but varies by case and foot dominance. You must get clearance from your medical team before driving.
How long will I be off work with a tarsal fracture?
It depends on your job. Sedentary roles may allow a rapid return. Manual or standing jobs, especially after surgery, may require up to 12 weeks or longer. You must be guided by your medical team on your return to work or other activities.
Can I run again after a calcaneal fracture?
You should have no concerns running after your calcaneal fracture heals, but recovery is gradual and may take several months. Return to high-impact activities should be guided by an orthopaedic specialist to ensure a safe return.
What happens if a tarsal fracture is missed or left untreated?
Undiagnosed tarsal fractures can lead to chronic pain, joint problems, and permanent foot changes. Early diagnosis is important for optimal healing and function. Access Ortho offers rapid appointments for acute orthopaedic injuries such as fractures.
How painful is recovery from tarsal bone surgery?
Some pain is expected postoperatively, especially early on. Pain is managed with medications, rest, and gradual rehabilitation. Most patients improve steadily over time.
Can I avoid surgery for my tarsal fracture?
Many fractures can be treated without surgery if they are stable and well-aligned. Your orthopaedic team at Access Ortho can determine the best course based on imaging and exam.
Why is my foot still swelling months after a tarsal fracture?
Swelling can persist for several months, especially after complex fractures or surgery. It usually improves with time, elevation, and rehab. If you have ongoing concerns, you should discuss these with your medical team.
What is the difference between a stress fracture and an acute fracture of the tarsal bones?
- Stress fractures develop over time from repetitive stress, such as running or other high-demand activities
- Acute fractures occur suddenly from a specific injury
- Both need rest and offloading, but stress fractures are often more subtle.
How do surgeons fix a comminuted calcaneal fracture?
Severely broken heel bones may require open reduction and internal fixation (ORIF) using plates and screws to realign and stabilise the fragments.
What is the success rate of non-surgical treatment for navicular fractures?
Non-displaced navicular fractures often respond well to immobilisation and rest, with high healing rates if diagnosed early. Surgery may be needed if the bone is displaced or unstable.
Can a tarsal fracture cause permanent changes to my foot shape?
Some fractures may cause permanent changes to foot shape, particularly if the fracture is displaced or involves joint surfaces. Without proper treatment, it can affect alignment, stability, and arch height. Early care helps prevent this.