#podiatrist

Apparently my actual anatomy is causing the stresses on my ankle tendons (literally all of them) because my arch is so high (ballerina flex tbh) it causes my foot to supinate which puts massive stress on all the tendons. Because of this, I’ve developed all the tendonitises and my ankle is extremely angry and tight. My doctor gave me a round of oral steroids, an insane brace, and I’m going to try both laser therapy and hopefully my insurance will cover custom orthotics.

Good morning and happy Thursday Colorado! We at Littleton foot and Ankle Clinic are gearing up for a rainy weekend and hope everyone stays safe!  Remember to wear the proper shoes if you go outdoors to keep those feet safe! Today we are discussing Talar Dome Lesion: 

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 does not 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 & 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 limited 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.

Nonsurgical Treatment 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 nonsurgical 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, nonweightbearing 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 reinjury if the ankle is unstable.

When Is Surgery Needed?

If nonsurgical 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:

Nonsteroidal or steroidal anti-inflammatory medications

Physical therapy

Bracing

Surgical intervention

As always, if you are experiencing any symptoms or anything of concern, please don’t hesitate to give our office a call! We would be more than happy to help! If you are from outside of Colorado, please give your PCP or local Podiatrist a call. If you have questions, we’re happy to help. Also, if you need us to check out you for an ankle fracture, bunions, custom orthotics, hammertoes, ingrown toenails, or any foot and ankle pain give us a call at (303) 933-5048 or visit our website at https://www.littletonfootandankleclinic.com At Littleton Foot and Ankle Clinic, we treat your feet.

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