- An OLT is damage to the cartilage and underlying bone of the talus — the ankle joint bone.
- It often develops after an ankle sprain or fracture and is a common cause of "the ankle never felt right again."
- Symptoms include deep ankle pain, catching, clicking, and intermittent swelling that doesn't fit a typical sprain pattern.
- MRI is the diagnostic test — X-rays often miss OLTs.
- Small lesions respond to immobilization and PT; larger or unstable lesions need arthroscopic surgery.
What are an osteochondral lesion of the talus?
An osteochondral lesion of the talus (OLT) — sometimes called a talar dome lesion — is damage to the cartilage and underlying bone of the talus, the bone at the top of the ankle joint. It typically develops after a significant ankle injury where the talus impacts the tibia, shearing off a fragment of cartilage and a small piece of underlying bone.
OLTs are commonly missed at the time of injury. The patient is treated for a "regular ankle sprain" and gets discharged. Months later, deep ankle pain, intermittent swelling, and a sense of catching or locking persist. MRI then shows the lesion.
At NES, any patient with persistent ankle pain beyond a typical sprain recovery is evaluated with MRI specifically to look for an OLT. Treatment depends on lesion size, location, and whether the fragment is stable.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
OLTs have a fairly characteristic symptom pattern after an injury:
- Deep ankle pain that persists weeks to months after an ankle sprain or fracture
- Catching, clicking, or locking sensation inside the ankle joint
- Intermittent swelling that doesn't fit a typical sprain recovery curve
- Pain with weight-bearing — particularly downhill walking or running
- A feeling that the ankle "isn't right" despite outwardly normal exams
- Stiffness, especially after activity
Why it develops
OLTs are almost always caused by mechanical injury:
- Severe ankle sprain with the talus impacting the tibia
- Ankle fracture
- Repetitive microtrauma in athletes
- Less commonly, a vascular event (idiopathic osteonecrosis) with no clear trauma
How we diagnose an osteochondral lesion of the talus
X-rays sometimes show an OLT but frequently miss them. MRI is the gold standard — it shows the cartilage, the bone marrow edema beneath it, and whether the fragment is stable or unstable.
Non-surgical care
Small, stable OLTs often do well with conservative care:
- Period of non-weight-bearing or protected weight-bearing in a boot
- Activity modification and physical therapy
- Custom orthotics to redistribute joint loading
- Anti-inflammatory medication
- Repeat imaging at 6–12 weeks to confirm healing
Surgical care
Larger, unstable, or symptom-persistent OLTs are treated surgically — almost always arthroscopically.
- Microfracture — drilling small holes in the underlying bone to stimulate fibrocartilage healing
- OATS (Osteochondral Autograft Transfer System) — transferring a plug of cartilage and bone
- Autologous chondrocyte implantation (ACI) — cell-based cartilage restoration
- Bone grafting with cartilage substitutes for larger lesions
Recovery depends on the procedure. Microfracture typically requires 6 weeks non-weight-bearing, transition to weight-bearing at 6 weeks, return to running at 4–6 months.
When to see a specialist
- Persistent ankle pain beyond 6 weeks after a sprain
- Catching or clicking inside the ankle joint
- Intermittent ankle swelling that comes and goes
- A feeling that your ankle isn't healing properly
OLTs are treated by Dr. Yama Dehqanzada and Dr. Thomas Melillo (both reconstructive podiatry), with Dr. Ron Bowman (MD orthopedics) co-managing larger lesions.