Osteochondral Lesion of the Talus
What are osteochondral lesions of the talus?
Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint). These injuries range from mild bruising to more severe damage such as blistering of the cartilage layers, cyst-like lesions within the bone, or fracture of the cartilage and bone layers. If there is significant damage to the cartilage in the ankle joint, arthritis may develop, resulting in chronic pain, swelling and limited motion.
How does an osteochondral lesion of the talus occur?
Osteochondral lesions usually occur as the result of an acute trauma, such as an ankle sprain. They can also occur from chronic, repetitive micro trauma. The affected bone and its covering of cartilage may stay in place and not cause any symptoms, or a fragment may gradually loosen and cause pain.
What are the symptoms?
Unless the injury is extensive, it may take months or even longer for symptoms to develop. Symptoms typically include:
- Continuous pain deep in the ankle, especially when bearing weight
- Ankle swelling and instability
- A clicking or catching feeling in the ankle when walking
- Immobility of the ankle
How is an osteochondral lesion of the talus diagnosed?
In addition to a physical exam and health history, your doctor can use specific tests, such as an MRI or CT scan, to confirm the diagnosis.
What is the treatment?
Treatment depends on the severity of the osteochondral injury. If the bone is only bruised and the lesion is stable (without loose pieces of cartilage or bone), non-surgical treatment may alleviate symptoms. Options include immobilization in a cast or boot, over-the-counter medications such as ibuprofen or acetaminophen, physical therapy or an ankle brace.
If conservative measures fail or a cyst has developed, surgery is required. The type of surgery depends on the size of the defect and the extent of bone and cartilage loss. The simplest surgical treatment is arthroscopy. In this procedure, the surgeon makes several small incisions around the ankle joint and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the joint. Tiny instruments are used to clean out the cyst.
Sometimes, more extensive surgery is necessary. Procedures range from arthroscopic debridement to remove injured cartilage and bone, fixation of the injured fragment, or grafting of bone and cartilage.
Recovery time varies depending on the procedure performed and the extent of the original injury.