Treatment depends on the severity of the osteochondral injury. If only bruising of the bone is present, resting the ankle may be all that is required. Many times, the initial injury to the talus is more severe with structural damage and worse symptoms. Immobilization of the ankle, medications, steroid injections and physical therapy are commonly tried but this often fails to relieve symptoms and surgery may be required.
The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect and the extent of bone and cartilage loss. The most common surgical treatment is arthroscopy of the ankle. Multiple tiny incisions are made around the ankle and a small camera is inserted to inspect the joint. Small instruments are then inserted into the joint to clean out inflammation and debris. A microfracture can then be performed by drilling holes into the underlying bone to fill the crater with a blood clot containing proteins and cells to restore a smooth surface. This technique is effective in approximately 85% of cases.
Occasionally, more extensive surgeries may need to be performed for cartilage repair. These can range from bone grafting to more sophisticated treatments in which portions of the talus have to be replaced using large grafts obtained from the patient’s knee or from a cadaver.
Recovery from these procedures depends upon the extent of the defect and whether it can be treated arthroscopically or through open incisions.