Osteochondral Lesion of the Talar Dome
(Also known as Talar Dome Lesion, Osteochondral Lesion)
What is an osteochondral lesion of the talar dome?
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot (figure 1). If these weight bearing forces are excessive and beyond what the bone can withstand, bony damage to the talus and its overlying cartilage may occur. This is known as an osteochondral lesion of the talar dome and can range from bruising of the cartilage to a complete fracture of the talus. Occasionally a bony fragment may separate from the talus and float within the ankle joint.
Causes of an osteochondral lesion of the talar dome
An osteochondral lesion of the talar dome typically occur during ankle sprains, particularly when there is a compressive component to the injury such as when landing from a jump.
Signs and symptoms of an osteochondral lesion of the talar dome
Patients with this condition typically experience pain that increases with excessive weight bearing activity and on firmly touching the talus. Symptoms vary depending on the severity of injury and may include: pain, swelling, stiffness and occasionally catching or locking of the ankle.
Diagnosis of an osteochondral lesion of the talar dome
A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose an osteochondral lesion of the talar dome. Investigations such as an MRI, CT scan or bone scan may be required to confirm diagnosis.
Treatment for an osteochondral lesion of the talar dome
All patients who potentially have this condition should be assessed by a physiotherapist to ensure accuracy of diagnosis and optimal treatment. If left untreated, osteochondral lesions of the talar dome can develop into arthritis. Appropriate management is therefore vital.
Treatment for osteochondral lesions of the talar dome vary depending on the severity of the injury. For mild injuries without fracture, treatment involves rest from any activity that increases pain. Crutches may be required to reduce weight bearing forces. Patients should be encouraged to pedal an exercise bike with low resistance to promote healing. Once pain-free, a gradual return to activity can occur provided there is no increase in symptoms.
Patients with more severe osteochondral lesions whereby obvious fracture is present may require plaster cast immobilization, the use of crutches, a protective boot or surgery. This may also be appropriate for those mild cases which are not responding to conservative measures. Surgery for these injuries typically involves an ankle arthroscope whereby the surgeon removes any separated bone fragments.
Physiotherapy for an osteochondral lesion of the talar dome
Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- anti-inflammatory advice
- joint mobilization
- ankle taping
- ankle bracing
- ice or heat treatment
- exercises to improve flexibility, strength and balance
- activity modification advice
- crutches prescription
- the use of a protective boot
- biomechanical correction
- a gradual return to activity program
Several factors may also slow the healing process and increase the likelihood of a poor outcome in patients with this condition. These factors should be assessed and corrected by the treating physiotherapist and may include:
- poor foot mechanics
- joint stiffness
- poor flexibility
- inadequate strength
- poor balance
Other intervention for an osteochondral lesion of the talar dome
Despite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Surgery, plaster cast immobilisation, the use of crutches or a protective boot may be indicated in patients with more severe injuries or in those cases that are unresponsive to conservative measures. A review with a podiatrist may also be indicated for the prescription of orthotics and appropriate footwear advice.
Exercises for an osteochondral lesion of the talar dome
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Foot and Ankle Up and Down
Move your foot and ankle up and down as far as possible and comfortable without pain (figure 6). Repeat 10 - 20 times provided there is no increase in symptoms.
Figure 6 – Foot and Ankle Up and Down (left leg)
Foot and Ankle In and Out
Move your foot and ankle in and out as far as possible and comfortable without pain (figure 7). Repeat 10 -20 times provided there is no increase in symptoms.
Figure 7 – Foot and Ankle In and Out (right leg)
With your hands against the wall, place your leg to be stretched in front of you as demonstrated (figure 8). Keep your heel down. Gently move your knee forward over your toes as far as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided there is no increase in symptoms.
Figure 8 – Lunge Stretch (right leg)
Find a Physio for an osteochondral lesion of the talar dome
Click here to find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome.
Other ankle exercises
View more ankle flexibility exercises.
View ankle strengthening exercises.
View balance exercises.
Physiotherapy products for an osteochondral lesion of the talar dome
Some of the most commonly recommended products by physiotherapist for patients with an osteochondral lesion of the talar dome include:
- Ice and Heat Packs
- Ankle Braces
- Ankle Supports
- Sports Tape (for protective taping)
- Wobble Boards (for rehabilitation)
To purchase physiotherapy products for an osteochondral lesion of the talar dome, click on one of the above links or visit the PhysioAdvisor Shop.
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