Ankle > Osteochondral Lesion of the Talus > Treatments

   Immobilization

Treatment Introduction

In patients under 30 years old, especially adolescents, the first line of treatment for osteochondral lesions usually is conservative. Physicians typically try immobilization and medication to help heal certain osteochondral lesions that are hindering your ability to walk or participate in activities. Adult patients probably do not have as good a chance of healing an osteochondral fracture with immobilization. Studies are inconclusive as to whether there is any benefit to immobilizing an osteochondral fracture in patients who are 20 or 30. The size and type of your cartilage lesion plays a big part in your physician’s decision on how to treat your ankle. When conservative treatment is appropriate, you typically have your ankle immobilized in either a short leg cast or a removable cam walker for at least four to six weeks. You usually are instructed to use crutches and bear no weight on your ankle while wearing the cast or cam walker.

   A short leg cast wraps around your foot, ankle, and lower leg. It starts below your knee and is open around your toes to allow toe movement. Short leg casts typically are made of layers of fiberglass. Your physician usually rolls a stockinette over your skin, and a dry layer of fiberglass is wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer.

   When the short leg cast dries, it should immobilize your ankle but allow you to move your toes. It should be snug but not tight; you should report any numbness of the foot or toes to your physician.

   A cam walker is a removable boot, made of nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to allow the range of motion your physician prescribes. The sturdy bottom of the cam walker is rocker shaped, which enables you to walk. Most patients are instructed to use crutches and not walk in their cam walker for about six weeks.

Physicians generally recommend that you avoid bearing weight until your ankle has healed. Crutches are usually prescribed for about six weeks after an osteochondral lesion. It can take a few months for the damaged cartilage to heal. Physicians generally play it safe and recommend you stay off the injured ankle until they are sure your ankle has a smooth cartilage surface. Younger patients, who more commonly receive conservative treatment, may find it difficult to use crutches for a prolonged time period, but it is essential to keep as much weight as possible off your ankle. The more weight you put on your ankle, the greater your chances of further damaging the cartilage on top of your foot. Household tasks that require you to be on your feet may be difficult for as long as six weeks. It may be helpful to have someone around the house who can help with any physical chores. In general, you should continue using your crutches and wearing your cast or cam walker as instructed by your doctor until symptoms resolve. Your physician usually schedules regular follow-up visits to check your progress at four weeks and then six to seven weeks after the injury. During the follow-up visits, your physician may decide to remove your cast and prescribe a cam walker. You will typically begin partial weight bearing in a brace or cam walker before going back to normal shoe wear. Depending on the size of your osteochondral fracture, your physician may prescribe range of motion exercises for you to perform at home after your cast is removed. The goal is to avoid pain and stimulate blood flow and circulation. Patients generally are instructed to remove their cam walker for a brief period and prop their lower leg 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. 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. Proper nutrition may help heal an osteochondral lesion. Your physician may suggest taking vitamin supplements. However, research has not yet proven how important nutrition is for healing, or which vitamins, minerals, or supplements are the most effective.

After healing from osteochondral lesion of the talus, you can help yourself avoid reinjury by making 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 fracture. 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. When physical therapy is prescribed, it is particularly important to strengthen the 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 of an osteochondral lesion. Once your 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.