Transchondral Fracture

A talar dome injury usually occurs as part of a sprained ankle or other traumatic event.

Symptoms of a transchondral lesion may be mild to severe pain within the ankle joint with motion at this joint. An acute (new) injury may have swelling, redness, and pain so severe it cannot be walked on. A chronic (old) injury may also have some swelling, but typically one can walk on it, but with increased annoying pain within the ankle. As the injury progresses the pain may become worse and its possible there maybe some feeling or sound of a clicking within the joint with motion. As a piece of cartilage or bone is fragmented from the dome this piece can rub within the ankle or become trapped between the joints involved with the talus, tibia and fibula.

Causes of a transchondral lesion are typically due to traumatic events. Many ankle sprains are assumed to be an injury to the lateral ligaments only, but in fact as the sprained ankle syndrome suggests there are possibilities of associated injurys including damage to the cartilage and bone of the ankle jont itself. Damage is most often thought to exist due to the shearing forces between the tibia and talus or fibula and talus as the ankle is sprained either laterally (outside) or medially (inside).

Prevention The best prevention may be to get advice from your podiatrist. Early diagnosis of the injury can be the most preventative.

Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce swelling and pain. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and determine if a talar dome lesion exists. Since cartilage is not seen on x-ray the injury may be subtle and your physician may additionally order a CT scan or MRI for evaluation. They may advise you on different shoewear, or place you in a cast, splint, or other immobilization device. Your podiatric physician may also recommend a procedure to actually fix the problem surgically.

Surgery to correct a talar dome lesion can greatly vary on location, bone quality, healing potential, and your activity level. Some lesions can be fixated using wires, pins, or screws. Others are debrided with small holes placed through the bone to promote a fibrocartilagenous growth. Occasionally a bone graft is used to replace the necrotic (dead) bone with a more viable (living) bone. Your podiatrist will give you advise on this. For more severe deformities and usually with long standing destruction of the joint an arthrodesis may be suggested to completely remove the motion of the ankle joint.

Post-operative Care and Risks are dependent upon the procedure performed and surgeons preference, which greatly vary. With any foot and ankle surgery you may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many procedures repairing the dome of the talus you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks or more depending on the procedure. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.