Talar Dome Lesion
![Talar Dome]()
What is a
Talar Dome Lesion?
The
ankle joint is composed of the bottom of the tibia (shin) bone and the top of
the talus (ankle) bone. The top of the talus is dome-shaped and is completely
covered with cartilage—a tough, rubbery tissue that enables the ankle to move
smoothly. A talar dome lesion is an injury to the cartilage and underlying bone
of the talus within the ankle joint. It is also called an osteochondral defect
(OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and
“chondral” refers to cartilage.
Talar dome lesions are usually caused by an injury, such as
an ankle sprain. If the cartilage doesn’t heal properly following the injury,
it softens and begins to break off. Sometimes a broken piece of the damaged
cartilage and bone will “float” in the ankle.
Signs and Symptoms
Unless the injury is extensive, it may take months, a year, or even longer for
symptoms to develop. The signs and symptoms of a talar dome lesion may include:
- Chronic
pain deep in the ankle—typically worse when bearing weight on the foot
(especially during sports) and less when resting
- An
occasional “clicking” or “catching” feeling in the ankle when walking
- A
sensation of the ankle “locking” or “giving out”
- Episodes
of swelling of the ankle—occurring when bearing weight and subsiding when
at rest
Diagnosis
A talar dome lesion can be difficult to diagnose, because the precise site of
the pain can be hard to pinpoint. To diagnose this injury, the foot and ankle
surgeon will question the patient about recent or previous injury and will
examine the foot and ankle, moving the ankle joint to help determine if there
is pain, clicking, or limitation of motion within that joint.
Sometimes the surgeon will inject the joint with an
anesthetic (pain-relieving medication) to see if the pain goes away for a
while, indicating that the pain is coming from inside the joint.
X-rays are taken, and often an MRI or other advanced imaging tests are ordered
to further evaluate the lesion and extent of the injury.
Treatment: Non-Surgical Approaches
Treatment depends on the severity of the talar dome lesion. If the lesion
is stable (without loose pieces of cartilage or bone), one or more of the
following non-surgical treatment options may be considered:
- Immobilization. Depending
on the type of injury, the leg may be placed in a cast or cast boot to
protect the talus. During this period of immobilization, non-weightbearing
range-of-motion exercises may be recommended.
- Oral
medications. Nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, may be helpful in reducing the pain and inflammation.
- Physical
therapy. Range-of-motion and strengthening exercises are
beneficial once the lesion is adequately healed. Physical therapy may also
include techniques to reduce pain and swelling.
- Ankle
brace. Wearing an ankle brace may help protect the patient
from re-injury if the ankle is unstable.
When is
Surgery Needed?
If non-surgical treatment fails to relieve the symptoms of talar dome
lesions, surgery may be necessary. Surgery may involve removal of the loose
bone and cartilage fragments within the joint and establishing an environment
for healing. A variety of surgical techniques is available to accomplish this.
The surgeon will select the best procedure based on the specific case.
Complications
of Talar Dome Lesions
Depending on the amount of damage to the cartilage in the ankle joint,
arthritis may develop in the joint, resulting in chronic pain, swelling and
limited joint motion. Treatment for these complications is best directed by a
foot and ankle surgeon, and may include one or more of the following
- Non-steroidal
or steroidal anti-inflammatory medications
- Physical
therapy
- Bracing
- Surgical
intervention
Information provided by The American College of Foot and Ankle Surgeons