Houston Methodist. Leading Medicine

Foot FAQ

Question:

I'm a ballet instructor at the college level. I don't perform anymore but I do demonstrate steps to my students. Now I have a problem called osteochondral talus.. The pain and swelling limit my motion. Sometimes it feels like the joint gets stuck. What can be done about this?

Answer:

Osteochondral lesion of the talus (OLT) refers to damage to the talus after an ankle sprain. The talus is a bone in the ankle between the calcaneus (heel bone) below and the tibia (shin bone) above. The bottom of the tibia forms a dome over the top of the talus. With OLT, a piece of cartilage from the talus gets pinched by this dome. In more severe cases, a fragment of cartilage breaks off the talus. In the worst cases, the fragment is floating free in the joint space. The first step for you may be to see an orthopedic surgeon (if you haven't already done this). The fact that you know you have OLT suggests you've already taken this step and received a diagnosis. Most studies support an initial treatment of conservative care. A physical therapist will work with you to mobilize the joint and decrease pain and swelling to restore motion. A program of flexibility and strengthening exercises is usually prescribed. Expect a four-to-six month period of rehabilitation. If your symptoms are not improved (or not improved enough), surgery may be advised. There are several ways to treat this condition surgically. For example, holes can be drilled in the talus where the fragment has broken off. This procedure is called microfracture. It stimulates new growth of fibrocartilage. Or the loose piece of cartilage can be removed (excision) with smoothing of the bone where the piece has broken off. And some patients may have both excision and drilling. The type of surgery performed is usually selected based on the severity of the condition. Mild cases of OLT with an intact joint cartilage have a better chance for a positive outcome. More severe injuries with disruption of the joint cartilage can degenerate with deterioration of the initial results. Once the surgeon is able to determine the location, type, and size of lesion, then specific treatment can be planned. Richard D. Ferkel, MD, et al. Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus. In The American Journal of Sports Medicine. September 2008. Vol. 36. No. 9. Pp.1750-1762.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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