Fractures of the Foot and Ankle

 

Stress Fracture

Toe Fracture and Metatarsal Fracture

Lisfrancs Fracture

Calcaneal Fracture

Talar Dome Fracture

Ankle Fracture

Osteochondral Lesion of the Talus Talar Dome Lesion

What Causes a Talar Osteochonral Lesion?

Cartilage damage of the ankle, also know as an osteochondral lesion of the talus or tibia, may occur from a traumatic fracture or sprain of the ankle. The bones in the ankle joint may bang against each other at the time of initial injury with damage to the cartilage surface.

Symptoms of Talar Dome Cartilage Damage

The initial pain may resolve with the original injury, but there may be internal pain of the ankle with activity and exercise. The pain is often a chronic aching pain with possible locking of the joint. Patients will often complain of swelling and a feeling of dull pain in the ankle. They also relate a mild to moderate injury such as an ankle sprain that has not improved.

Picture showing an ankle joint that has suffered damage to the cartilage following a sprain. The arrow is pointing to the area of damage on the outside of ankle.

Diagnosis of a Talar Dome Lesion:

The diagnosis of talar cartilage damage also known as an osteochondral lesion of the talus is often done with x-rays and/or an MRI. Initial x-rays are done to check the alignment of the foot and ankle and also check for any sort of bone damage along with the cartilage damage. With an MRI, the ligament structures, tendons and cartilage of the ankle can be checked and analyzed.

Picture showing an MRi of the ankle in cross section from front to back. The arrow is pointing the light area on the joint cartilage where the cartilage is damaged.

Conservative Treatment of Osteochonral Lesions of the Talus:

Conservative care of cartilage damage is only performed on lesions that are small and well attached. In cases of cartilage crush damage of bone and cartilage bruising, a cast or boot with crutches is used to allow the cartilage and bone time to rest and recover. In certain cases, the body can replenish blood to the region of damage and allow the tissue to heal. In certain cases, a bone stimulator which is a special machine that increases blood to the bone may be used to increase blood to the region of injury.

Surgical Care of Osteochondral Lesions of the Talus:

In small size osteochondral lesions of the talus, the surgical treatment option most often performed is arthroscopic removal of the damaged cartilage and drilling of the damaged region in order to grow new cartilage called fibrocartilage.

Picture showing schematic of surgical repair of the damaged cartilage. The chip of cartilage is removed. Then the bone is drilled to encourage fibrocartilage to grow in place of the missing cartilage.

If the lesion is large or involves the deep bone below the cartilage damage area, a transplant of fresh bone and cartilage, either from the patient’s knee or from a lab, is placed as a plug into the damaged region.

Visible Region of Cartilage and Bone Damage (yellow arrow) in the Ankle Joint
Fresh Replacement Talus for Harvest and Transplant of Cartilage and Bone	Transplanted Cartilage and Bone (yellow arrow) Just Prior to Final Positioning Press Fit

 

University Foot and Ankle Institute is involved in extensive research on cartilage repair. We are proud to be working on a new technique that allows us to take chips of cartilage and glue them into the damage area with minimally invasive techniques.

Although all forms of osteochonrdal lesion treatment options are performed at our locations and each patient is treated with the best option for their situation, University Foot and Ankle Institute is one of the top centers in the world in the treatment of large osteochondral lesions of the talus with fresh cartilage transplant and cartilage glueing procedures.

Our Podiatrists, surgeons and physical therapists are the very best in California. Request an appointment with a doctor at our Los Angeles or other Southern California offices.