Ortho Dx: A man with years of ankle pain - Clinical Advisor

Ortho Dx: A man with years of ankle pain

Slideshow

  • Anteroposterior radiograph of a 42-year-old man with a 6-week history of severe right ankle pain

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    Anteroposterior radiograph of a 42-year-old man with a 6-week history of severe right ankle pain

  • Mortise view radiograph of the patient’s ankle

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    Mortise view radiograph of the patient’s ankle

  • Lateral view radiograph of the patient’s ankle

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    Lateral view radiograph of the patient’s ankle

A 42-year-old man presents with a 6-week history of severe right ankle pain. He has had intermittent pain in the ankle for 3 to 4 years, but it has never been this severe. He is now having trouble standing and stocking shelves at work. Anteroposterior, mortise, and lateral view radiographs are taken.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

The patient has an osteochondral lesion of the medial talar dome. An osteochondral lesion is an injury to an area of subchondral bone and overlying cartilage.In most cases, the injury is a result of trauma such as an ankle sprain....

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The patient has an osteochondral lesion of the medial talar dome. An osteochondral lesion is an injury to an area of subchondral bone and overlying cartilage.

In most cases, the injury is a result of trauma such as an ankle sprain. During an ankle sprain, the tibia may hit the talus, causing a compression or shearing injury. However, people may have ankle pain for several weeks before seeking treatment and often do not recall a specific injury. Therefore, suspicion for osteochondral lesion should be high for anyone with a history of ankle sprain and chronic pain.1

Those with suspected or confirmed osteochondral lesions should undergo magnetic resonance imaging (MRI). MRI helps visualize the integrity of the subchondral bone and overlying cartilage, which aids in guiding treatment, and helps rule out other ankle pathology that might be the source of pain.

Osteochondral lesions can be treated with a nonweight-bearing cast for 6 to 12 weeks. The success rate with nonoperative treatment is relatively low at 45% to 55%. If conservative treatment fails or if the lesion is large and found soon after injury, arthroscopic debridement and bone marrow stimulation with subchondral antegrade drilling is the most common treatment.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. van Bergen CJ, Kox LS, Mass M, Siervelt IN, Kerkhoffs GM, van Dijk N. Arthroscopic treatment of osteochondral defects of the talus: outcomes at 8 to 20 years of follow-up. J Bone Joint Surg Am. 2013;95:519-525.
  2. Szatkowski J. Osteochondral lesions of the talus. http://www.orthobullets.com/foot-and-ankle/7034/osteochondral-lesions-of-the-talus. Accessed December 15, 2016.

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