Sports Medicine
Sports Injury Prevention & Rehabilitation

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Osteochondral Lesion of the Talar Dome

Also known as Talar Dome Lesion, Osteochondral Lesion)
What is an osteochondral lesion of the talar dome?
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot. If these weight bearing forces are excessive and beyond what the bone can withstand, bony damage to the talus and its overlying cartilage may occur. This is known as an osteochondral lesion of the talar dome and can range from bruising of the cartilage to a complete fracture of the talus. Occasionally a bony fragment may separate from the talus and float within the ankle joint.

Causes of an osteochondral lesion of the talar dome
An osteochondral lesion of the talar dome typically occur during ankle sprains, particularly when there is a compressive component to the injury such as when landing from a jump.

Signs and symptoms of an osteochondral lesion of the talar dome

Patients with this condition typically experience pain that increases with excessive weight bearing activity and on firmly touching the talus. Symptoms vary depending on the severity of injury and may include: pain, swelling, stiffness and occasionally catching or locking of the ankle.

Diagnosis of an osteochondral lesion of the talar dome

A thorough subjective and objective examination from a doctor is necessary to diagnose an osteochondral lesion of the talar dome. Investigations such as an MRI, CT scan or bone scan may be required to confirm diagnosis.

Treatment for an osteochondral lesion of the talar dome
All patients who potentially have this condition should be assessed by a doctor to ensure accuracy of diagnosis and optimal treatment. If left untreated, osteochondral lesions of the talar dome can develop into arthritis. Appropriate management is therefore vital.
Treatment for osteochondral lesions of the talar dome vary depending on the severity of the injury. For mild injuries without fracture, treatment involves rest from any activity that increases pain. Crutches may be required to reduce weight bearing forces. Patients should be encouraged to pedal an exercise bike with low resistance to promote healing. Once pain-free, a gradual return to activity can occur provided there is no increase in symptoms.
Patients with more severe osteochondral lesions whereby obvious fracture is present may require plaster cast immobilization, the use of crutches, a protective boot or surgery. This may also be appropriate for those mild cases which are not responding to conservative measures. Surgery for these injuries typically involves an ankle arthroscope whereby the surgeon removes any separated bone fragments.

Physical therapy for an osteochondral lesion of the talar dome

Physical therapy treatment is vital for all patients with an osteochondral lesion of the talar dome to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • ankle taping
  • ankle bracing
  • ice or heat treatment
  • exercises to improve flexibility, strength and balance
  • education
  • activity modification advice
  • crutches prescription
  • the use of a protective boot
  • biomechanical correction
  • a gradual return to activity program

Several factors may also slow the healing process and increase the likelihood of a poor outcome in patients with this condition. These factors should be assessed and corrected by the treating therapist and may include:
  • poor foot mechanics
  • joint stiffness
  • poor flexibility
  • inadequate strength
  • poor balance

Other intervention for an osteochondral lesion of the talar dome

Despite appropriate therapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Surgery, plaster cast immobilisation, the use of crutches or a protective boot may be indicated in patients with more severe injuries or in those cases that are unresponsive to conservative measures. A review with a podiatrist may also be indicated for the prescription of orthotics and appropriate footwear advice.