Ankle Osteochondral Lesions
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Search Strategy[edit | edit source]
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Definition/Description[edit | edit source]
Symptomatic osteochondral ankle defects often require surgical treatment. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. The defects cause deep ankle pain associated with weightbearing. Impaired function, limited range of motion, stiffness, catching, locking and swelling may be present. These symptoms place the ability to walk, work and perform sports at risk.
Epidemiology /Etiology[edit | edit source]
As the foot was inverted on the leg, the lateral border of the talar dome was compressed against the face of the fibula. When the lateral ligament ruptured, avulsion of the chip began. With the use of excessive inverting force, the talus within the mortise was rotated laterally in the frontal plane, impacting and compressing the lateral talar margin against the articular surface of the fibula. A portion of the talar margin was sheared off from the main body of the talus, which caused the lateral OD. A medial lesion was reproduced by plantarflexing the ankle in combination with slight anterior displacement of the talus on the tibia, inversion and internal rotation of the talus on the tibia.
As the foot is inverted on the leg, the lateral border is compressed against the face of the fibula (stage I), while the collateral ligament remains intact. Further inversion ruptures the lateral ligament and begins avulsion of the chip (stage II), which may be completely detached but remain in place (stage III) or be displaced by inversion (stage IV).
Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Physiotherapy 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
- 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 physiotherapist and may include:
- poor foot mechanics
- joint stiffness
- poor flexibility
- inadequate strength
- poor balance
If there is no sign of result, further investigation is required. 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. A review with a podiatrist may also be indicated for the prescription of orthotics and appropriate footwear advice.
Exercises for the foot are plantar flexion, dorsal flexion, eversion and inversion movements. The patient have to do these movements without feeling any pain and with a repetition of 10 – 20 times. Without increase in symptoms. Another exercise is the lunge stretch, hold for 5 seconds and repeat 10 times. The knee can not come before the toes. Also no increase in symptoms. Al those exercise has to be painless.
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