Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Chronic ankle pain that lingers for months after an “ankle sprain” is often not a sprain at all — it may be an osteochondral lesion of the talus (OLT), a cartilage injury within the ankle joint that is routinely missed on initial X-rays and commonly undertreated. Understanding this diagnosis is essential for anyone with persistent ankle symptoms that haven’t responded to standard sprain rehabilitation.

What Is an Osteochondral Lesion?

An osteochondral lesion (also called osteochondritis dissecans of the ankle, or OLT) is a focal area of damage to the cartilage covering the dome of the talus — the upper surface of the ankle bone — along with the underlying subchondral bone. The injury disrupts the smooth articulating surface of the ankle joint, causing chronic pain, swelling, stiffness, and catching or locking sensations.

OLTs most commonly occur at the medial (inner) or lateral (outer) shoulder of the talar dome, with medial lesions being more common. They are classified by size, depth, and stability of the cartilage fragment.

Causes of Osteochondral Ankle Lesions

The most common cause is a single traumatic event — particularly an ankle sprain or fracture that impacts the talar dome against the fibula or tibia. Lateral OLTs are strongly associated with inversion ankle sprains, where the talus impacts the fibula. Medial OLTs are associated with external rotation forces during ankle injuries.

Some osteochondral lesions develop from repetitive microtrauma without a single defining injury, or from avascular necrosis of a small segment of the talar dome. These atraumatic lesions are more common in patients with diabetes, systemic lupus, or corticosteroid use.

Symptoms of an OLT

The hallmark of an osteochondral lesion is persistent ankle pain that fails to resolve after a typical ankle sprain recovery period (6–8 weeks). Symptoms include deep ankle aching with activity, swelling that recurs with prolonged walking or sports, a feeling of the ankle “giving way” or catching, and stiffness after periods of rest. Symptoms are often nonspecific, which is why OLTs are commonly missed without advanced imaging.

Diagnosis

Standard X-rays miss the majority of osteochondral lesions, particularly in the early stages when the fragment has not yet separated. MRI is the diagnostic gold standard — it accurately identifies the lesion location, size, cartilage integrity, and degree of subchondral bone involvement. CT scanning provides superior bony detail for surgical planning. Diagnostic ultrasound can detect associated synovitis and joint effusion but cannot visualize the cartilage directly.

Conservative Treatment

Small, stable osteochondral lesions — particularly in younger patients with intact cartilage — may heal with conservative management:

• Non-weight-bearing immobilization (cast or boot) for 6–8 weeks
• Formal physical therapy emphasizing ankle proprioception and progressive strengthening
• Activity modification to avoid high-impact loading during healing
• PRP injection to support cartilage healing in selected cases

Surgical Treatment

Larger lesions, unstable fragments, or cases failing conservative management require surgical intervention:

• Arthroscopic debridement and microfracture: The standard first-line surgical procedure for lesions under 15mm. The damaged cartilage is debrided and the subchondral bone is perforated with tiny holes (microfracture), stimulating fibrocartilage repair tissue. Recovery takes 3–6 months with excellent outcomes for appropriately selected lesions.
• Osteochondral autograft transfer (OATS): Cylindrical osteochondral plugs are harvested from a non-weight-bearing knee area and transplanted to the ankle defect, providing hyaline cartilage rather than fibrocartilage repair. Preferred for larger lesions or microfracture failures.
• Autologous chondrocyte implantation (ACI): A two-stage procedure where cartilage cells are harvested, cultured in the laboratory, then re-implanted in a scaffold to fill the defect. Used for large or complex lesions in younger patients.
• Allograft transplantation: Donor osteochondral tissue fills large defects that are beyond the scope of autograft techniques.

Osteochondral Lesions of the Ankle — Advanced Treatment in Michigan

Ankle cartilage damage causing chronic pain and instability? Our podiatric surgeons offer advanced diagnostic imaging and surgical repair options including arthroscopic procedures.

Learn About Our Ankle Treatment Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Zengerink M, et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 2010;18(2):238-246.
2. Hannon CP, et al. Osteochondral lesions of the talus: aspects of current management. The Bone & Joint Journal, 2014;96-B(2):164-171.
3. Savage-Elliott I, et al. Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot & Ankle Specialist, 2014;7(5):414-422.

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.