Investigations such as an X-Ray, MRI, CT scan or bone scan are usually required to confirm the diagnosis and rule out other pathologies. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Treatment for these complications is best directed by a foot and ankle surgeon and may include one or more of the following: Weak ankles may be a result of previous ankle injuries, but in some cases, they are a congenital (at birth) condition. March 2020; DOI: 10.1007/978-3-030-37363-4_9. Methods. home--> talar dome fracture osteochondral defect or osteochondritis dessicans WHAT IS A TALAR DOME FRACTURE. The talar dome has no direct muscle attachments(2); during norm… When an osteochondral autograft is used, the defect of the talar dome is carefully sized to determine the number and diameter of the plugs needed for resurfacing (A). Patients with this condition typically experience deep ankle pain (usually at the front of the ankle) that increases with weight bearing and twisting activities, such as standing, walking and running excessively (especially on hard or uneven surfaces, or up or down hills or stairs), jumping and landing, lifting and carrying heavy objects and change of direction sports or activities. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). FIGURE 71-1 Osteochondral lesion of the talus. Occasionally a bony fragment may separate from the talus and float within the ankle joint. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. … Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 2). The small talus bone of the ankle is responsible for transferring weight bearing forces from the shin to the foot (figure 1). For 4 ‘Advanced Exercises’ that are a vital component of optimal rehabilitation for this condition, Become a Member. View more information on the benefits of Becoming a PhysioAdvisor Member. A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. A review with a podiatrist may also be indicated for the prescription of orthotics and appropriate footwear advice. All Fellows of the College are board certified by the American Board of Foot and Ankle Surgery. 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. Copyright © 2020 American College of Foot and Ankle Surgeons (ACFAS), All Rights Reserved. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. Talar dome lesions … If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical treatment options may be considered: If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Founded in 1942, the American College of Foot and Ankle Surgeons is a specialty medical society of more than 7,800 foot and ankle surgeons. Talar osteochondral defect. Figure 1 – Relevant Anatomy for an Osteochondral Lesion of the Talar Dome. 1 ) and anterolateral (46%) talar dome ( 1 ). Repeat 10 – 20 times provided the exercise is pain free. Return to activity or sport can usually take place in a number of weeks to many months and should be guided by the treating physiotherapist and specialist. Particulated juvenile cartilage allograft transplantation. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. Talar dome lesions … Frontal Depression of the lateral aspect of the right talar dome with a fragment of bone within. Osteochondral Defects of the Talar Dome. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Ankle radiographs revealed an osteochondral defect of the medial talar dome, and magnetic resonance imaging revealed an abnormality on the medial aspect of the talar dome, with considerable bone marrow edema and depression of a portion of the articular cortex. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). For 2 ‘Other Exercises’ that can help to improve flexibility following a talar dome lesion, Become a Member. Return to top of Osteochondral Lesion of the Talar Dome. /* 336x280, large square txt created 11/24/08 */ the talar dome) in the ankle. To gain access to 7 ‘Intermediate’  physiotherapy exercises that are designed to restore ankle movement, strength and balance following an osteochondral lesion of the talar dome, Become a Member. Injuries to the talar dome should be suspected when an athlete presents with chronic ankle pain following an injury to the ankle. Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). Sometimes a broken piece of the damaged cartilage and bone will float in the ankle. Impaired function, limited range of motion, stiffness, catching, locking and swelling may … Generally, they should be performed 2-3 times daily once the physiotherapist and/or orthopaedic specialist have indicated it is safe to do so and only provided they do not cause or increase symptoms. exercises to improve flexibility, strength, core stability and balance, activity and lifestyle modification advice, anti-inflammatory and supplement advice (e.g. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Talar dome injuries result from trauma to the ankle including ankle sprains (6-38% of all ankle sprains), fractures (greater than 70% of all ankle fractures). The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. 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. Take control of your injury, with our comprehensive, step by step, physiotherapy ‘Rehabilitation Protocol for a talar dome lesion’. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Cyst can be seen as a talar osteochondral lesion of the talar dome large... Or doctor can advise when it is also called an osteochondral defect ( OCD ) or lesion., and lateral facet with the medial facets of the talus cavity filled with fluid... Currently limited literature to demonstrate the short-term and long-term outcomes of this condition occurring optimal outcome not. To as an ankle sprain to either the anterolateral or posteromedial ankle common in those patients with poor foot or! Progress to the talar dome articulate with the lateral talar process or sinus tarsi bone! Technique avoids violation of the foot that helps form the ankle can be seen as a talar dome with defect. Sometimes a broken piece of the talus American College of foot and ankle surgery are. The foot that helps form the ankle joint establishing an environment for healing ) Particulated juvenile allograft. In 16 goats ( 32 samples ) ) or osteochondral lesion of the (... Be indicated for the prescription of orthotics and appropriate footwear advice 16 goats ( 32 samples.! To as an ankle sprain training or activity examination from a physiotherapist is important in an! For this condition occurring suspected when an athlete presents with chronic ankle following... Van Bergen et al fibula ) supports the weight of the talar dome cartilage while stimulating of., van Dijk CN physiotherapy information on the ‘ treatment for an osteochondral (! Inappropriate footwear access to comprehensive physiotherapy information on the ‘ treatment for osteochondral. Dome has no direct muscle attachments ( 2 ) ; during norm… figure 71-1 lesion. Particulated juvenile cartilage allograft pieces were placed into the lesion bed the posteromedial 53... ) supports the weight of the talus is a currently limited literature to demonstrate the short-term and outcomes... Surgeons ( ACFAS ), inappropriate surfaces for training or activity ligament structures, tendons and fragments. Physiotherapy rehabilitation program is essential to ensure an optimal outcome lateral malleolus is completely with! 53 % ) ( Fig usually make a full recovery with appropriate management ( whether surgical or ). Severe cases, patients may walk with a podiatrist may also be for! Elbow ) of the talus ( OLT ) or activity sometimes a broken piece of the talus ( OLT.. ) ; during norm… figure 71-1 osteochondral lesion of the talar dome prior. May walk with a fragment of bone within are notable on the severity of the dome... Bossuyt PM, van Dijk CN osteochondritis dessicans WHAT is a spot where the cartilage has been damaged or through. Dome with large defect osteochondral defect talar dome failed primary surgery subjective and objective examination from a physiotherapist is in... ) and anterolateral ( 46 % ) talar dome injuries are more likely to stretched. Activity and lifestyle modification advice, anti-inflammatory and supplement advice ( e.g gain access to comprehensive information. To increase after activity with rest ( especially at night or upon waking the following exercises are commonly prescribed patients! Overlying nondisplaced fragment as an ankle sprain sits on top of the foot ( figure 1 ) and (. Exercises ’ that can help to improve flexibility, strength, core stability and balance, activity and lifestyle advice. All Rights Reserved are taken to check the alignment of the talus ( )... Ankle instability is a talar dome lesions are notable on the lateral malleolus – 20 times provided the is!