Osteochondral Lesions of the Talus

Osteochondral lesions of the talus

Osteochondral lesions of the talus are fractures of the cartilage, which sits on top of the Talus (ankle bone). They commonly occur in combination with an ankle sprain. It may not be diagnosed immediately but only later identified if an ankle sprain doesn’t fully heal.

Ankle supports

Signs and Symptoms

  • Symptoms of an Osteochondral lesion of the talus or ankle bone include pain in the ankle with swelling.
  • The ankle may catch or lock and is likely to be stiff.
  • More detailed bone scans, MRIs, or surgery may be required for a full diagnosis.

What is an Osteochondral lesion of the talus?

Osteochondral lesions or fractures of the cartilage which sits on top of the Talus (ankle bone), most commonly occur in combination with an ankle sprain. This is especially common if the injury occurs when landing on to the ankle, as the Tibia above compresses the top of the Talus, damaging the covering cartilage.

Osteochondral fractures in association with a sprain are often not detected initially. The sprain is usually treated and the ankle improves to an extent but may continue to cause problems such as pain and swelling after activity, at which point further investigations may be made. Large fractures may be evident on X-rays. MRI scans, isotopic bone scans, and CT scans are more likely to pick up smaller lesions.

Osteochondral lesions can be graded 1-5, with 1 being the least severe:

I – Subchondral fracture.
II – Chondral fracture.
IIa – Subchondral cyst.
III – Chondral fracture with separate but not displaced fragments.
IV – Chondral fracture with separate and displaced fragments.

Cold therapy

If Osteochondral injury is not detected, it may eventually lead to Osteoarthritis of the ankle1.

Treatment of Osteochondral Lesions of the talus

  • Grade I and II lesions are treated conservatively. This means without surgery.
  • Previously it has been recommended that the ankle is cast to immobilize the ankle and allow healing, however, this is no longer recommended as joint motion without loading has been found to promote cartilage healing.
  • Weight-bearing activities should be avoided and instead replaced with cycling/swimming to maintain fitness and keep the ankle mobile.
  • Grade I and II injuries that do not heal within 3 months may be put forward for surgery.
  • Grade III and IV injuries require an ankle arthroscopy (keyhole surgery) to remove the separated fragments.
  • A full rehabilitation program to regain ankle strength, flexibility, and balance is then undertaken.

References & further reading

  1. Lee M, Kwon JW, Choi WJ, et al. Comparison of outcomes for osteochondral lesions of the talus with and without chronic lateral ankle instability. Foot Ankle Int 2015;36(9): 1050–7.

Related articles

  • Foot stress frqacture

    The talus bone is the bone at the top of the ankle which the tibia or shin bone sits on. A stress fracture of the…

  • Osteochondritis dissecans

    Osteochondritis dissecans or Osteochondral fracture is a tear of the cartilage which covers the ends of the bone within a joint. It can occur in…

  • Medial malleolus ankle

    The medial malleolus is the bony bit on the inside of the ankle. A stress fracture of the medial malleolus is rare, causing gradual onset…

  • Dislocated ankle bones

    A dislocated ankle is a severe injury which usually happens in conjunction with a fracture or complete rupture of the lateral ankle ligaments. They are…

  • Jones fracture

    Jones fracture is a fracture of the 5th metatarsal bone on the outside of the foot, which may occur through overuse, or following a severe…

  • Acute ankle injuries

    Acute ankle injuries include sprains, strains, and fractures. They occur suddenly as opposed to developing gradually over time. Sprained ankle An ankle sprain is one…

  • Ankle avulsion fracture

    An ankle avulsion fracture occurs when a tendon or ligament tears, pulling a small piece of bone with it. The symptoms are similar to an…

  • Calf strain exercises

    Lower leg and ankle rehabilitation exercises for ankle, shin, and calf injuries. Once pain allows, isometric or static exercises can begin, followed by dynamic strengthening…

  • Ankle pain

    Acute ankle pain occurs suddenly and includes sprains, strains, and fractures. Chronic ankle injuries develop gradually over time, often through overuse. Acute ankle injuries (sprains,…

  • When to see a doctor about ankle injuries

    The majority of ankle injuries, especially the minor ones can be treated at home. However, if you have any of the following symptoms you should…

Scroll to Top