Osteochondral lesions of the talus are uncommon sources of ankle pain in athletes that can occur after traumatic ankle sprains. They are often found incidentally on ankle x-rays obtained for ankle sprains or to rule out ankle fractures. In patients and athletes with pain in the ankle joint from a presumed ankle sprain but with persistent symptoms, x-rays, CT scans, or MRIs can reveal the diagnosis.

The lesion itself is an injury to the cartilage and subchondral bone within the ankle joint. They can occur laterally on the talus or medially.

Osteochondral lesion of the talus (medial)
Pain from an osteochondral lesion of the talus can also be felt on the inside of the ankle joint (white arrow).

Treatment of an osteochondral lesion of the talus

Some of these lesions can be treated nonoperatively with immobilization and limitation of weightbearing. If the fragment is displaced, surgery is usually required. Surgery can consist of arthroscopically drilling the lesion or performing a microfracture of it. Depending on the size and location, using a cylinder of bone and cartilage from the patient or from a donor might be needed.

Return to sports with this ankle injury

Return to sports depends on healing of the lesion, but this is a significant surgery. Return to sports in the same season is unlikely, as it can take many months to get back to full running and athletic activities.

Osteochondral lesion of the talus (lateral)
Pain from an osteochondral lesion of the talus can be felt on the lateral side of the ankle joint (white arrow).

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