What Causes an Osteochondral Lesion of the Talus

Most osteochondral lesions of the talus occur after a traumatic injury such as an ankle sprain or fracture. About 85% of these injuries result from a direct ankle injury.

Repetitive stress from activities like running or jumping can also lead to this condition when the top of the talus repeatedly collides with the tibia or fibula. Chronic ankle instability, common in athletes or individuals with recurrent ankle injuries, further increases the risk.

Common symptoms include:

• Locking or catching in the joint

• Weakness and instability

• Stiffness

• Swelling, pain, and tenderness

• Limited range of motion

• A loose fragment in the joint

• Bony edema visible on imaging studies

Poorly healing lesions may cause persistent pain and loss of function, especially if a fracture or instability is present.

If you’re experiencing symptoms like ankle pain, stiffness, or swelling, consider scheduling an appointment with a Resurgens Foot and Ankle physician today.

How Is an Osteochondral Lesion of the Talus Diagnosed?

During your appointment, your Resurgens physician will ask about the cause and severity of your ankle injury and review your medical history. A physical exam will be performed to assess your range of motion and pinpoint pain or instability. Some brief discomfort during this process is normal.

Advanced imaging tests, such as magnetic resonance imaging (MRI), may be used to evaluate the extent of damage, check for bony edema, and examine the cartilage. In some cases, arthroscopy allows the physician to view the lesion directly and measure its size to guide treatment.

Once your evaluation is complete, your physician will discuss treatment options and create a customized plan for your condition.

Osteochondral Lesion of the Talus Treatment

Because each injury is unique, treatment varies depending on the lesion’s size, severity, and symptoms. The goal of treatment is to relieve pain and restore normal ankle function. Small lesions are often treated conservatively, while larger or more complex injuries may require surgery.

In simpler terms, treatment options range from rest and therapy to surgery, depending on how badly the bone and cartilage are affected.

Non-Surgical Treatment

Non-surgical treatment is often effective for smaller lesions that have stable cartilage and mild symptoms. Options include:

• Resting the ankle and avoiding strenuous activity

• Physical therapy to improve strength, motion, and flexibility

• Ice and elevation to reduce swelling and pain

• Over-the-counter anti-inflammatories for pain management

• Braces, casts, or crutches to limit stress on the ankle

Surgical Treatment

If non-surgical treatments do not relieve symptoms, surgery may be recommended to repair the damaged area. Several procedures can help restore function and relieve pain, including:

• Arthroscopic debridement: The surgeon cleans out damaged tissue and may perform a microfracture procedure, creating tiny holes in the bone to stimulate new cartilage growth. This is usually effective for smaller defects and offers excellent results in most patients.

• Osteochondral autograft transfer (OATs procedure): Healthy cartilage and bone are taken from another area, usually the knee, and transplanted to the damaged talus. This is used when earlier treatments fail or the lesion is large. Some patients may experience knee discomfort at the donor site.

• Osteochondral allograft transplantation: In this procedure, cartilage and bone from a donor are used to replace the damaged area. It is typically used for large or previously failed cases where autografts are not suitable.

• Autologous chondrocyte implantation: This advanced procedure uses a patient’s own cultured cartilage cells to repair larger cartilage defects.

• Medial malleolar osteotomy: Sometimes necessary to access hard-to-reach lesions, this technique allows better visibility for grafting or implantation.

• Platelet-rich plasma (PRP) or bone marrow aspirate: These biological therapies can help enhance healing.

These surgeries are typically performed by orthopedic surgeons who specialize in foot and ankle conditions.

Post-Operative Care: What to Expect

Following surgery, a structured recovery plan is essential for optimal healing. During the first few days, the focus is on managing pain and swelling with rest, ice, and elevation. Your orthopedic surgeon will provide detailed instructions on medications and care.

You will likely need to avoid putting weight on the ankle at first, using crutches or a walker to stay mobile. As you recover, your care team will introduce progressive weight-bearing and physical therapy exercises to rebuild strength, flexibility, and motion.

Physical therapy is critical for recovery, helping restore function and minimize pain. Your therapist will guide you through a personalized rehabilitation plan. Regular follow-ups with your surgeon ensure your ankle is healing properly and that your treatment plan is on track.

By following your post-operative instructions and attending all appointments, you can reduce complications and support full recovery. With time and consistency, most patients regain strength and mobility, returning to their normal activities with confidence.

If you’re dealing with chronic ankle pain, don’t wait. Schedule an appointment with a Resurgens Foot and Ankle specialist today.