Treatment Options for OCD Talus

What is OCD talus and does it always require surgery for treatment?

The talus is one of the bones that makes up the ankle joint. It is located between the calcaneus, which is the heel bone, and the bones of the lower leg, the tibia, and the fibula. The top of the talus bone, where the tibia sits, is shaped like a dome and is covered with articular cartilage, which makes the smooth movement of the joint possible. As the main connector between the leg and foot, the talus facilitates the transfer of body weight and stress to the other parts of the ankle. 

Osteochondritis dissecans (OCD) of the talus, also referred to as an osteochondral lesion, is an area of abnormal or damaged cartilage and bone on the upper part of the talus. Typically, the damage is the result of an injury, often a severe ankle sprain. It can, however, develop over time due to the excess pressure created by a misaligned or unstable ankle joint. If the affected area is located on the outside of the top of the talus, it was likely caused by recent trauma, like a sprained ankle. If the damage is on the inside of the top of the bone, the cause is more often from chronic injuries or sprains.

Symptoms of OCD Talus

There may not be any symptoms of a talus lesion for months or even a year or more. Depending upon the extent of the damage or if healing is incomplete, the cartilage may begin to soften and break off and there may be bone fragments in or around the ankle. When symptoms do begin to develop, they typically include:

  • Ongoing ankle pain often referred to as a dull ache
  • Especially deep pain in the ankle while walking and immediately after
  • Swelling
  • Stiffness
  • Feeling that the ankle gets “locked” at times

Treatment Options for OCD Talus

Treatment recommendations will be different based on the condition and lifestyle of the patient. Some of the most common considerations will include:

  • Age and body weight
  • Severity of symptoms
  • Size and location of the lesion
  • Goals and expectations of the patient

Nonsurgical options may be suggested if there are no fragments of bone or cartilage. These will typically include some combination of:

  • Immobilization – this may include a boot  or ankle brace
  • Physical therapy – to restore strength and range of motion once healing has taken place

If these conservative measures prove unsuccessful or if there is too much damage to begin with, due to the lesion being especially large or there are fragments of bone or cartilage floating around within the joint, surgery will likely be recommended. Various procedures are used to repair damage to the bone and cartilage of the talus and the decision will be made on an individual basis. Basically, these repairs will consist of:

  • Drilling into the bone and creating new pathways for blood flow, with the goal of additional nourishment accelerating healing in the bone
  • Using pins and screws to stabilize the lesion if the recent injury
  • In cases of significant damage, a graft of bone and cartilage may be used, which will also facilitate bone and cartilage regeneration in the damaged area 

If you have questions about OCD talus or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Bergen County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.

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