Ankle pain that won’t go away after an injury could be more serious than you think. If you’re experiencing deep ankle pain, clicking sounds, or instability months after an ankle sprain, you might have an osteochondral lesion of the talar dome.
This condition involves damage to both bone and cartilage in your ankle joint. Understanding what it is and how to treat it can help you get back to normal activities without ongoing pain.
What Is an Osteochondral Lesion?
An osteochondral lesion is damage to both cartilage and the underlying bone, similar to a pothole in your joint’s smooth surface. When this protective cushion and supporting structure get injured, movement becomes painful.
This condition affects the talus, a bone in the ankle positioned between the shin and heel. The talus is crucial for mobility and bears your full body weight during walking or running.
Doctors may refer to it as osteochondritis dissecans, talar osteochondral defect, or OLT, all terms that describe the same condition. Ankles are particularly vulnerable because they support a significant amount of weight while moving in multiple directions.
What Causes Osteochondral Lesions?
Most osteochondral lesions happen after ankle injuries. Severe ankle sprains are the most common cause of this condition. When your ankle twists badly, the bones can knock together with great force, damaging the cartilage and bone.
Ankle fractures can also cause these lesions. The break itself or the impact that caused it can damage the talar dome. Sports injuries are particularly common, especially in sports such as football, basketball, and running.
However, not all cases involve obvious trauma. Some people develop osteochondral lesions from:
- Repeated small injuries over time
- Chronic ankle instability
- Poor ankle alignment
- Previous ankle injuries that didn’t heal properly
Certain factors increase your risk. Young athletes are most commonly affected, particularly those in their teens and twenties. People with a history of ankle injuries are also more likely to develop these lesions.
The exact mechanism varies, but essentially, the cartilage becomes compressed, twisted, or damaged to the point that it can’t recover. Sometimes, a piece of cartilage and bone breaks away from the surface of the joint.
Symptoms of Osteochondral Lesions
The main symptom is deep ankle pain that gets worse when you put weight on your foot. This isn’t the sharp pain you might feel from a sprain, but rather a deep, aching pain that seems to come from inside your ankle joint.
Many people notice a clicking or catching feeling when they move their ankle. This happens when the damaged cartilage catches on other surfaces in the joint. You might hear actual clicking sounds when you walk.
Other common symptoms include:
- Ankle weakness and instability
- Stiffness, especially in the morning
- Swelling around the ankle
- Difficulty moving your ankle fully
- Pain when walking on uneven ground
- Problems going up or down stairs
The pain often comes and goes initially. You might have good days and bad days. Without treatment, symptoms usually get worse over time. The ankle may feel like it’s going to give way, making you feel unsteady on your feet.
Athletes often notice they can’t perform at their usual level. Running, jumping, and quick direction changes become painful or impossible.
How Are Osteochondral Lesions Diagnosed?
Physical Examination:
- The doctor presses on different ankle areas to locate pain
- Test ankle movement and flexibility
- Checks for joint instability by moving the ankle in various directions
- Assesses walking pattern and weight-bearing ability
Foot and ankle imaging tests:
- X-rays:
- Shows bone damage clearly
- Cannot show cartilage detail well
- May miss small lesions
- MRI scans:
- Highly sensitive and specific for osteochondral lesions
- Shows both cartilage and bone damage in detail
- Rarely misses lesions or gives false results
- Helps doctors assess the exact extent of damage
- Ultrasounds:
- Ultrasound uses high-frequency sound waves to create detailed images of foot and ankle structures without any invasive procedures
- Can identify tendon tears, ligament injuries, muscle pathology, nerve problems, and localised inflammation throughout the foot and ankle
- Provides essential information that helps podiatrists accurately diagnose issues and develop appropriate treatment strategies
Severity Grading:
- Doctors grade lesions to determine severity
- The grading system guides treatment decisions
- Small, stable lesions – conservative treatment is often successful
- Large or unstable lesions usually require surgery
Osteochondral Lesion Treatment Options
Osteochondral lesion treatment depends on several factors, including the size of the lesion, your symptoms, and your level of activity. Treatment usually starts with conservative approaches.
Conservative treatment works well for small, stable lesions. This includes:
- Rest from painful activities
- Using crutches to reduce weight on the ankle
- Wearing a cast or boot for 4-6 weeks
- Taking anti-inflammatory medications like ibuprofen
- Physical therapy once the pain improves
- Ankle bracing for support during activities
Recovery and Rehabilitation
Recovery follows a structured progression regardless of whether you have surgery or conservative treatment. Initially, you’ll need to protect the ankle from weight-bearing. This gives the lesion time to begin healing.
Gradually, you’ll progress to partial weight-bearing, then full weight-bearing as pain allows. Physical therapy helps restore ankle movement, strength, and stability. This phase is crucial because weak, stiff ankles are more likely to develop problems again.
Athletes need sport-specific ankle rehabilitation before returning to competition. This ensures the ankle can handle the demands of their particular sport.
The long-term outlook is generally good with proper treatment. However, some people develop arthritis in the ankle joint years later, especially if the lesion was large or treatment was delayed.
When to See a Podiatrist
See a specialist if ankle pain persists for more than a few weeks after an injury. Don’t ignore ongoing pain, especially if you have clicking, catching, or instability.
Athletes should be particularly careful about persistent ankle symptoms. Continuing to play through pain can make lesions worse and harder to treat.
Early diagnosis and treatment give the best results. Waiting months or years before seeking help often means more complex treatment and longer recovery times.
If you’re experiencing persistent ankle pain, clicking, or instability, don’t wait. Our experts at Highett Podiatry will provide a professional assessment to determine if you have this condition and to identify the most suitable treatment approach for your situation. Contact us today.
Frequently Asked Questions
What is an osteochondral lesion of the talar dome?
An osteochondral lesion of the talar dome is damage to both cartilage and bone at the top of the ankle. It causes deep ankle pain, a clicking sensation, and instability.
How do you treat an osteochondral lesion?
Osteochondral lesion treatment starts with rest, immobilisation, and rehabilitation for small lesions. Large or unstable lesions usually need surgery to remove damaged tissue or replace it.
Can osteochondral lesions heal on their own?
Small, stable osteochondral lesions can heal with proper conservative treatment. However, larger lesions rarely heal completely without surgery.
How long does it take to recover from an osteochondral lesion?
Recovery from osteochondral lesion of the talus takes 6-12 weeks with conservative treatment or 3-6 months after surgery. Athletes may need longer before returning to sport.
What causes osteochondral lesions in the ankle?
Most osteochondral lesions result from ankle sprains, fractures, or repeated trauma. Chronic ankle instability and poor alignment also contribute to development.