Ankle Locking Explained: What You Need to Know About Osteochondral Lesions

If you’ve noticed that your ankle locks frequently when you walk, especially after an ankle sprain or impact injury, you could be dealing with an osteochondral lesion. These injuries affect the cartilage that covers the talus bone, which is called the talar dome, and the talus bone itself, a key component of the ankle joint. If left untreated, osteochondral lesions can lead to pain, stiffness and instability in the foot and ankle. Read on to learn everything you need to know about these lesions.

What is an Osteochondral Lesion?

An osteochondral lesion is damage or injury to the cartilage and underlying talus bone within the ankle joint. This damage is often the result of a traumatic injury or a chronic condition that causes repeated stress over time. The word “lesion” is a general term that can describe a variety of types of damage, including:

• Cartilage softening or tearing, which happens when the cartilage becomes worn or detached.
• Bone bruising or microfractures, which occur when the bone beneath the cartilage is bruised or has tiny fractures.
• Loose fragments, which are pieces of cartilage or bone that detach from the talus bone and may stay in place or float within the ankle joint.
• Cyst formation, although it’s fairly uncommon, can happen in some cases when fluid from the joint accumulates and forms cysts beneath the cartilage.

Common Symptoms

Symptoms of osteochondral lesions can vary depending on the extent of the damage, but most patients experience intense ankle pain, especially when bearing weight. You may also feel a locking sensation during movement, which is often accompanied by swelling, stiffness and instability. You may also hear or feel clicking or popping while moving the ankle. Many patients say that it feels like the ankle isn’t moving smoothly or is “catching.” Although this isn’t always the case, the ankle may also be tender to the touch.

How it’s Diagnosed

Typically, diagnosing an osteochondral lesion involves a physical examination and imaging tests. First, a podiatrist will review your symptoms and then perform an examination on your ankle, assessing range of motion, stability and tenderness. Imaging tests like X-rays, MRIs and CT scans are often used to confirm the diagnosis and reveal the extent of the damage to the cartilage and talus bone. These scans also help your podiatrist determine the best treatment course.

Non-Surgical Treatment Options

The right treatment for osteochondral lesions depends on multiple factors, including the severity of the injury, the patient’s age and activity level, and the patient’s overall health. In cases where the lesion is less severe or the patient is younger, usually before adulthood, non-surgical treatments may be an option. These treatments include rest, immobilization, anti-inflammatory medications and wearing a brace. More often than not, your podiatrist will recommend activity modifications, like avoiding weight-bearing activities, to reduce stress on the joints and allow healing to take place. Your podiatrist may also recommend physical therapy to help restore range of motion and strength in the ankle. 

Surgical Treatment Options

If the lesion is more severe or unstable, surgery is often required. One of the most common procedures used to treat osteochondral lesions of the talar dome is arthroscopic debridement. During this procedure, the damaged cartilage and loose fragments are removed from the joint. Other procedures to treat osteochondral lesions involve the grafting of cartilage and bone or the fixation of the fragments using small surgical screws or pins. Recovery times vary from patient to patient, but it can take several weeks or months to fully heal, and this is when rest, bracing and physical therapy become essential.

When to See a Foot and Ankle Specialist

If you’re experiencing ankle pain, swelling or locking that doesn’t improve with rest, especially after an injury or prolonged stress to the ankle joint, then it’s time to see a podiatrist. Early diagnosis and treatment are key for preventing further damage, and prompt care may help you avoid more invasive treatments down the line.

Osteochondral lesions are a common yet often overlooked cause of ankle locking. Whether your symptoms began after a recent injury or have been lingering for some time, the expert foot and ankle specialists in Irving at North Texas Foot & Ankle are here to provide an accurate diagnosis and effective treatment plan. We support you every step of the way through non-surgical and surgical treatment options to help you get back on your feet. Schedule an appointment with our dedicated team today!