What is the treatment for a Stieda process fracture?

Treatment of Stieda Process Fracture

The treatment for a Stieda process fracture is primarily conservative management with immobilization using a short-leg cast for approximately 6 weeks, provided the fracture is non-displaced. 1

Understanding Stieda Process Fractures

• A Stieda process fracture is a fracture of the lateral process of the talus that can occur as part of posterior ankle impingement syndrome 2
• This fracture can be mistaken for an ankle sprain due to similar clinical presentation including pain and swelling 1
• Early recognition through appropriate imaging is crucial for proper management and favorable outcomes 1

Treatment Algorithm

For Non-Displaced Stieda Process Fractures:

• First-line treatment: Conservative management with immobilization using a short-leg cast for 6 weeks 1
• Monitor for healing with radiographic follow-up at approximately 3 weeks and at the time of immobilization removal 3
• After immobilization, progressive rehabilitation should be initiated to restore range of motion and strength

For Displaced Fractures or Those Failing Conservative Treatment:

• Surgical intervention may be necessary if:

  • The fracture is significantly displaced (>3mm) 3
  • Conservative treatment fails to relieve symptoms 2
  • There is persistent impingement between the tibia and calcaneus 2

• Surgical options include:

  • Arthroscopic excision of the fractured Stieda process through posterior lateral and trans-Achilles portals 2
  • Open surgical approach for larger or more complex fractures 4

Post-Treatment Considerations

• Active finger motion exercises should be performed during immobilization to prevent stiffness 3
• Return to sports activities can typically be achieved approximately 8 weeks after surgical intervention 2
• Physical therapy focusing on range of motion, strength, and proprioception is recommended after immobilization period

Potential Complications

• Persistent posterior ankle pain due to inadequate treatment 2
• Skin irritation or muscle atrophy from prolonged immobilization (occurs in approximately 14.7% of cases) 3
• Posterior impingement syndrome if the fracture heals with prominence 2

Special Considerations

• In dancers and athletes who perform activities requiring extreme plantar flexion, surgical excision may be necessary to prevent recurrent impingement, even with small fracture fragments 4
• Arthroscopic approaches allow for faster return to sports compared to open procedures, but the specific approach should be based on fracture characteristics and surgeon expertise 2, 4