Osteochondral Lesion of the Talus (OLT)
Also referred to as Osteochondral Defect (OCD) or Talar Dome Lesion
The Talus is the bone that makes up the bottom portion, or inside, of the ankle joint. and acts as the major "hinge joint" for the entire foot and ankle. Approximately 70% of the talus is covered with cartilage, and it participates in the Ankle Joint, Subtalar Joint, and Talo-Navicular Joint.
An Osteochondral Lesion (OLT) is an injury in which the cartilage ("chondral"), and sometimes the bone ("osteo") beneath the cartilage, becomes damaged. The cause is primarily a traumatic injury to the ankle, but this condition can also present in patients with no history of injury. Sometimes, a piece of cartilage or bone will break off the talus and move around the inside of the joint.
Symptoms of an OLT:
- Deep Pain within the ankle joint. Worse with standing and movement. Relieved with rest.
- Occasional "clicking" sensation with ankle motion.
- Sensation of the ankle "locking up" when walking.
- Swelling around the ankle may occur after increased activities.
Properly diagnosing an OLT can be difficult and often requires evaluation by a well trained foot and ankle surgeon. A complete clinical history, including history of major or minor ankle injuries, along with a thorough physical exam is crucial. Assessing ankle range of motion and checking for any ankle impingement is important. X-rays are standard, and MRI or CT is commonly used to establish a correct diagnosis.
Complete evaluation of the ankle, and surrounding structures is critical when assessing an OLT. Many times, there will be other pathology, such as lateral ankle instability or peroneal tendinitis. Dr. McSpadden co-authored a publication finding that 63% of patients with an OLT also had peroneal tendon pathology, as noted on MRI.
After identifying an OLT, along with any associated injuries, non-surgical and surgical treatment options are evaluated. Non-surgical treatments include AFO bracing, anti-inflammatory medication, steroid injections, and physical therapy. These treatments will not cure the OLT and usually only offer temporary pain relief. The downside to non-surgical treatment, or no treatment, is an increased likelihood of full blown ankle arthritis, down the road, which may require ankle fusion or replacement surgery.
Surgical options for treatment of OLT have advanced rapidly over the last several years. Many procedures are now offered through Arthroscopic Surgery, which allow for a more rapid return to full activities. Surgical options can vary based on the size and location of the OLT. Lesions that are greater than 1.5 sq cm or located on the back portion of the talus are more difficult to treat with minimal incision techniques, and often require reconstructive surgery to correct.
Surgical Options for OLT:
- Arthroscopic Surgery
- Cartilage Replacement
- Stem Cell Treatment
- Ankle Fusion
- Ankle Replacement