Osteochondral Lesion of the Talus

The talus is the uppermost bone in the foot that, together with the tibia, makes up the ankle joint. The top of the talus is a dome-shaped area that is completely covered with cartilage to allow for smooth, painless movement of the joint. When the ankle joint is injured, the cartilage may become torn or fractured leading to a condition called an osteochondral lesion of the talus. In severe cases, as piece of cartilage may even break off but stay wedged in place. Also known as a talar dome lesion, this condition causes pain and swelling within the ankle, and left untreated, may lead to long-term damage to the bone.

Symptoms of Osteochondral Lesion of the Talus

Symptoms of osteochondral lesions of the talus tend to develop gradually, and may not be immediately noticeable. An osteochondral lesion often causes:

  • Chronic pain in the ankle
  • Clicking or catching feeling when walking
  • Feeling that the ankle will give out
  • Swelling

Symptoms are usually worse when weight is put on the foot and are not as severe when the foot is at rest. As this condition progresses, symptoms may worsen, especially if there is loose pieces of cartilage or bone within the ankle. Left untreated, osteochondral lesions may cause chronic pain and swelling, and may eventually limit the motion of the joint.

Causes of Osteochondral Lesion of the Talus

Osteochondral lesions are usually caused by an injury, such as an ankle sprain, which damages the cartilage and forces it to soften and slowly break off. A broken piece of cartilage may remain in the ankle, causing an osteochondral lesion to occur. A lesion may not develop until months or even years after an injury occurs, unless the injury is severe. This condition may also be caused by abnormal bone development, which is most commonly seen in children. Repeated trauma to the ankle over time can also cause osteochondral lesions to gradually develop.

Diagnosis of Osteochondral Lesion of the Talus

An osteochondral lesion of the talus is often missed during the early diagnosis of ankle injuries, since an injury such as a sprain is usually considered minor and does not require treatment. However, if pain and swelling persist, an osteochondral lesion may be suspected. In addition to a physical examination of the ankle and foot, imaging tests such as X-rays and MRI scans may be performed to diagnose an osteochondral lesion of the talus.

Treatment for Osteochondral Lesion of the Talus

Treatment for osteochondral lesions of the talus usually begins with conservative methods to help relieve pain caused by stable lesions with no loose cartilage or bone. Conservative treatment methods may include:

  • Nonsteroidal anti-inflammatory drugs
  • Immobilization
  • Physical therapy
  • Ankle brace

If these methods fail to relieve the symptoms of the lesion, surgery may be needed. Surgery for this condition may involve removing the loose cartilage or bone within the joint and promote healing of the talus. There are several different surgical techniques available to treat this condition. These techniques vary depending on the size, location and severity of the lesion. After surgery, most patients experience permanent relief from ankle pain and swelling caused by the lesion.

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