Most ankle sprains settle within a few weeks. In some people, though, pain, swelling or stiffness carries on for months. One important cause of deep ankle pain long after a sprain is an osteochondral lesion of the talus.
What is an osteochondral lesion of the talus?
The talus sits at the centre of the ankle joint and passes body weight from the leg into the foot. More than half of its surface is covered with cartilage, yet its blood supply is limited, so injuries do not always heal on their own.
“Osteo” means bone and “chondral” means cartilage. An osteochondral lesion is damage to both the cartilage and the bone underneath it. We now know that much of the pain, and the progression of the condition, comes from changes in that underlying bone.
What are the symptoms?
- Deep ankle pain that is hard to point to
- Pain that increases with walking, running, stairs or sport
- Swelling at the end of the day or after exercise
- Catching or locking if a fragment has come loose
- Reduced movement
- Repeated sprains when a ligament injury is also present
Pain that persists weeks after a sprain, symptoms that continue despite a normal X-ray, and swelling that does not respond to treatment should all raise the possibility of cartilage damage.
What causes it?
The most common cause is injury: ankle sprains, sports with sudden changes of direction, and ankle fractures, many of which damage the joint surface. Repeated minor trauma, chronic ankle instability and alignment problems can also contribute. Over time bone marrow oedema, cysts and separation of the cartilage may develop.
How is it diagnosed?
The examination looks at where the pain is, range of motion, ankle stability and alignment. An X-ray comes first, but small lesions may not show. MRI shows cartilage damage, bone marrow oedema and cysts. CT gives a detailed picture of the lesion size and bone structure and is particularly useful when planning surgery.
Can it be treated without surgery?
Not every lesion needs an operation. For small lesions or mild symptoms, activity modification, anti-inflammatory medication, physiotherapy, a supportive brace and weight control may be recommended to unload the joint and make daily life easier. The plan depends on your age, activity level, how long symptoms have lasted, lesion size and the extent of bone damage.
What are the surgical options?
Many lesions are treated with ankle arthroscopy, which lets the surgeon see the damage directly, clean it and repair it in the same session.
- Microfracture: after damaged cartilage is removed, small holes are made in the bone so that marrow cells can reach the area and form repair tissue. Mainly used for small lesions.
- Cartilage regeneration techniques: AMIC, scaffold-based and biologically augmented methods may be chosen for larger lesions.
- Osteochondral grafting: when the bone is badly damaged, healthy bone and cartilage are transferred into the defect. Used for large or cystic lesions and after failed previous surgery.
- TOPIC technique: bone and periosteum from the pelvis are used to rebuild a large damaged area of the talus.
Assoc. Prof. Tokgöz co-authored a finite element study on how cartilage thickness mismatch affects joint pressures in knee-to-talus osteochondral grafting, published in Joint Diseases and Related Surgery.
Recovery and return to sport
Recovery depends on the technique and the size of the lesion. Repair tissue takes time to mature, so weight-bearing is usually limited in the first weeks while controlled movement and physiotherapy begin early. Return to daily activities usually takes from a few weeks to a few months, and return to sport is usually planned gradually over several months. Timing varies from person to person.
Frequently asked questions
My X-ray is normal but the pain will not go. Could it be cartilage damage?
Yes. Small lesions often do not show on X-ray. If symptoms persist, an MRI may be needed.
Does cartilage damage heal on its own?
Because the talus has a limited blood supply, damage does not always heal by itself, although some small lesions improve with non-surgical care.
What happens if it is not treated?
Some lesions enlarge over time, a cartilage fragment may come loose, and the risk of arthritis later in life can rise. Long-lasting pain is worth investigating.