Lesion of the Talus > Treatments
Your physician can use an arthroscope
- a tiny camera with about a three to five millimeter
diameter - to take a look at the top of your talus in
the ankle joint. Using small incisions, microsurgery
instruments can be used to repair damaged bone and cartilage
in your ankle after an osteochondral lesion. Surgery
is more commonly prescribed for adult patients. Arthroscopy
is sometimes useful as a diagnostic tool when MRI
(magnetic resonance imaging) is inconclusive. Your physician
may be able to make the final diagnosis and surgically
repair your talus within a few hours. The surgery for
an osteochondral ankle lesion typically is a step-by-step
procedure, which moves from the final diagnosis through
various surgical steps depending on the extent of damage
in your talus. Small lesions may only need to have the
cartilage smoothed over, whereas large lesions may require
a surgeon to make a larger incision and remove loose
chips of bone and cartilage.
Preparing for Surgery
If you and your physician have decided on arthroscopic
surgery to repair your osteochondral lesion, the decisions
you make and the actions you take before your surgery
can be every bit as important as the procedure itself
in ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for these from your doctor before
you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
possible, practice walking with your crutches so you
are ready to use them after surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
sure the orthopedist performing the surgery is board-certified
or eligible, which can be determined by calling the
American Board of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
Day of Surgery
At most medical centers, you will go to "patient
admissions" to check in for your operation. There
may be separate check-in areas for ambulatory outpatients
(patients go home the same day after surgery) and for
overnight inpatient surgery, so be sure to ask your
doctor or one of his assistants about this. After you
have checked in to the hospital, you will go to a holding
area where the final preparations are made. The mandatory
paperwork is completed, and your ankle may be shaved,
though this is not always necessary. You will be asked
to change into a hospital gown and, if applicable, remove
your watch, glasses, dentures, and jewelry. You will
have the opportunity to speak with your orthopedic surgeon
or one of his assistants and meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). An IV (intravenous) line may
be inserted into your arm at this time. You will then
walk or ride on a stretcher to the operating room. Most
patients are not sedated until they go into the operating
room. Here are some important steps to remember for
the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, arrange for someone to drive you home
when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgery to treat an osteochondral ankle lesion is a
series of steps that usually starts with the least invasive
technique, an arthroscope,
as the last step of diagnosis before your surgeon progresses
with whatever needs to be done to repair the top of
your talus. Small osteochondral lesions may only require
the first few steps, whereas large lesions usually require
more complex procedures. Spinal anesthesia typically
is given to numb you from the waist down and you usually
are sedated so you sleep through the procedure. Surgery
can last up to two hours.
surgeon inserts an arthroscope through a quarter-inch
incision and views the cartilage lesions on your talus.
One or two additional small incisions, or "portals,"
will be made to allow the insertion of instruments into
is injected into the ankle joint through one of these
portals, which allows the surgeon to view, through the
arthroscope, the extent of the cartilage damage.
the first step is debridement. Your surgeon cleans up
rough edges of frayed or damaged cartilage to smooth
the cartilage surface.
which is the removal of any dead or fractured bone from
the lesion, is performed if bone has been chipped underneath
your talar cartilage. Any loose pieces of bone and cartilage
on how stable the bone fragments are and how large the
cartilage lesion is, the next surgical option is to
drill the fractured area with an instrument called a
encourages blood flow and growth of fibrocartilage,
which is the type of cartilage your body regrows in
response to damage. You normally have a coating of hyaline
cartilage on top of your talus, which cannot regrow.
Fibrocartilage is not as proficient or as ideal as hyaline
cartilage because it is not as strong, nor does it absorb
shock as well, during movements. But fibrocartilage
usually is sufficient to relieve pain and enable normal
movement in your ankle.
rare cases, open surgery can be the final step if your
osteochondral lesion is large or in a position where
the arthroscope cannot properly visualize the lesion.
Debridement, curettage, and drilling are similarly performed.
usually are closed with stitches and your ankle is put
into a splint to immobilize it. You are then taken to
the recovery room.
surgery for an osteochondral ankle lesion, you will
be transported to the recovery room where you will be
closely observed for one to two hours while the immediate
effects of anesthesia wear off. Your ankle will be immobilized
in a splint or cast when you wake up and your ankle
will be elevated. After surgery, you usually experience
some pain. Adequate pain medications will be prescribed
for you. You will either be given an IV patient-controlled
analgesia (PCA) device, a device that delivers pain
medications in safe amounts when you push a button,
or prescribed oral, IV, or intramuscular pain medications
when you ask for them. Your surgeon will prescribe crutches
and you are usually instructed to keep all weight off
your ankle for at least six weeks. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse who, with the help of the doctor, will determine
when you can prepare to go home. You will normally be
able to leave the hospital or clinic within three to
four hours after surgery. Make sure to have someone
available to drive you home, as you will be unable to
drive a car.
After undergoing surgery to repair an osteochondral
lesion of the talus, physicians generally recommend
that you avoid bearing weight until your ankle has healed.
Crutches are usually prescribed for about six weeks,
and you should rest as much as possible with your ankle
elevated above your heart level. This helps blood drain
away from your ankle and controls swelling. For two
or three days after surgery, most patients are instructed
to stay off their feet and rest. You may be able to
get around more after about three days, but you should
continue to elevate your ankle as much as possible and
use your crutches to keep weight off your ankle. You
may need to use pain medication prescribed by your physician
for one or two days after surgery. Pain usually decreases
within a few days. Household tasks that require you
to be on your feet may be difficult. It can be helpful
to have someone around the house who can help with any
physical chores. Patients commonly return to their physician’s
office within 10 to 14 days to have the post-surgery
ankle splint replaced by a short leg cast. You typically
are instructed to keep the cast dry. Either wrap a plastic
garbage bag around the cast while showering or bathe
with your leg out of the tub.
While wearing a cast, you probably will have to use
crutches for six to eight weeks. Typically, you will
return to your physician for check-up visits every few
weeks. Depending on the extent of surgery, your cast
will be removed and your ankle will be put into a removable
cam walker. A cam walker is a type of boot splint made
of nylon straps that secure around your lower leg and
foot to hold your ankle in place. There is usually an
adjustable ankle hinge that can be set to allow some
limited ankle motion. Patients generally are instructed
to remove their cam walker for a brief period to perform
simple range of motion exercises. Prop your leg up on
a stool or pillow so your ankle is off the floor. Physicians
generally recommend moving your ankle up, down, and
side-to-side. Start with slow movements and do not move
your ankle too far in any direction. In general, you
should continue using your crutches and wearing your
cast or cam walker as instructed by your doctor until
symptoms resolve. You typically begin partial weight
bearing in a brace or cam walker before going back to
normal shoe wear. Your physician may suggest physical
therapy that can be done at home, or refer you to a
physical therapist after about six weeks. However, many
patients can strengthen their ankles without formal
physical therapy. Your physician generally evaluates
your ankle after six weeks and determines whether regular
cardiovascular exercise and everyday weight bearing
can sufficiently strengthen your ankle. Massage and
heat therapy also may be used to soothe muscle pain.
However, massaging an injured ankle can disrupt the
healing process. Your physician will decide when it
is safe to begin ankle massage. A balanced diet, vitamin
supplements, proper hydration, and exercise may help
you recuperate and get you back on your feet again.
You may be able to perform workouts with your upper
body that can give you a cardiovascular workout while
you are seated.
to call the doctor after surgery
The recovery period after an osteochondral lesion usually
lasts six months to a year. Typically, you progress
from range-of-motion exercises to light cardiovascular
exercise and then strengthening exercises. If you experience
episodes of minor swelling or pain while exercising,
have your physician examine your ankle. Formal physical
therapy is prescribed for patients who do not make good
progress strengthening their ankles on their own. Physical
therapy usually involves learning and performing ankle
stretching and foot and lower leg strengthening
To prevent reinjury after an osteochondral lesion,
you should make sure you have equal strength in both
the injured and uninjured ankles. A strong and flexible
ankle may be more able to withstand any abnormal positions
and strain that occur during sports and activities.
Before you engage in sports and activities that involve
twisting and jumping, physicians generally recommend
that you focus on building up your cardiovascular fitness.
Begin slowly, and avoid overusing your ankle. Physicians
often recommend a cross-training approach that alternates
your workouts each day between impact activities like
jogging, and low impact activities like swimming or
cycling. The amount of weight training you may need
to strengthen your ankle and prevent reinjury varies
greatly depending on your age and the size of the osteochondral
lesion. Older patients may need to undergo a specific
leg and ankle strengthening program under the supervision
of a physical therapist. Younger patients are more likely
to regain full ankle strength after range of motion
exercises and standard cardiovascular fitness training.
It is particularly important to maintain strength in
your peroneal muscles, located on the outside of your
lower leg around your small lower leg bone (fibula).
The peroneals help keep your ankle from turning inward,
which can damage the cartilage on top of your foot bone.
Though the recovery period may be lengthy, most patients
can safely return to sports and activities within nine
months to a year of an osteochondral lesion. Once your
ankle lesion heals and you have equal strength in both
ankles, the cartilage typically is stable, especially
in younger patients, and reinjury is rare. A small amount
of pain is normal during activities. If you feel so
much pain in your ankle to warrant taking a painkiller
before an activity, visit your physician for a checkup.