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

An osteochondral lesion of the talus (OLT) is a defect in the cartilage and underlying bone of the talus — often caused by ankle trauma — that presents as persistent deep ankle pain, swelling, and locking or clicking after an ankle sprain that “won’t heal.” It is one of the most commonly missed diagnoses after ankle sprain, requiring MRI for detection since standard X-rays are frequently negative. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan evaluates and manages osteochondral lesions of the talus.

What Is an Osteochondral Lesion?

The articular surface of the talus is covered with hyaline cartilage that allows frictionless ankle joint motion. An osteochondral lesion occurs when trauma — typically an ankle sprain or direct impact — shears the cartilage off the underlying bone, leaving a raw bone surface. The lesion may be stable (cartilage still partially attached), unstable (cartilage loose but still in place), or loose body (cartilage fragment free within the joint). OLTs most commonly occur at the medial talar dome (from eversion injuries) or the anterolateral talar dome (from inversion injuries). The surrounding cartilage has minimal blood supply and poor intrinsic healing capacity — which is why these lesions persist rather than healing on their own.

Why Ankle Sprains Don’t Always “Heal”

An ankle sprain that continues to cause pain, swelling, or instability beyond 6–8 weeks should raise suspicion for an osteochondral lesion or other structural pathology. Studies show that approximately 6–7% of ankle sprains have an associated OLT. The clinical presentation overlaps with chronic ankle instability — deep ankle pain, a sense of the ankle “giving way,” swelling that doesn’t fully resolve, and occasional catching or locking sensations. Standard ankle X-rays miss most OLTs because the cartilage is invisible on plain radiographs and early bony changes may be subtle. MRI is the definitive diagnostic test.

Diagnosis

MRI with thin-slice coronal and sagittal sequences is the gold standard for OLT diagnosis, characterizing the lesion size, depth, stability, and whether there is subchondral cyst formation. CT scanning adds detail about the bony component, particularly for surgical planning. Arthroscopy is both diagnostic and therapeutic — allowing direct visualization of the lesion and immediate treatment. Classification systems (Berndt and Harty, Ferkel and Sgaglione) guide treatment decisions based on lesion size and stability.

Conservative Treatment

Small, stable OLTs in skeletally immature patients or those without significant mechanical symptoms can be managed conservatively with 6–12 weeks of non-weightbearing or protected weightbearing in a CAM boot, followed by progressive rehabilitation. The goal is to allow fibrocartilaginous healing of the lesion. Success rates for conservative management are higher in pediatric patients and lower in adults with larger lesions, loose bodies, or subchondral cysts. Conservative management is less likely to succeed in lesions >15mm diameter, unstable lesions, and lesions with an associated loose body.

Surgical Treatment Options

Arthroscopic surgery is the most common intervention. Techniques depend on lesion size and characteristics. Bone marrow stimulation (microfracture or drilling): for primary small-to-medium lesions (<150mm²), creates bleeding channels to stimulate fibrocartilage formation — good outcomes in 80–85% of appropriately selected patients. Autologous chondrocyte implantation (ACI): for large lesions or failed prior surgery, involves harvesting cartilage cells, culturing them, and reimplanting — most technically demanding, best for large defects. Osteochondral autograft transfer (OATS): harvests a cylindrical plug of bone and cartilage from a non-weight-bearing area and transplants it to fill the defect — effective for medium lesions. Recovery from arthroscopic bone marrow stimulation: non-weightbearing 6 weeks, return to sport 4–6 months.

Most Common Diagnostic Mistake

The most common mistake is continuing to treat what appears to be chronic ankle instability with physiotherapy and bracing when the underlying cause is an untreated OLT. Ligament rehabilitation does not address cartilage pathology, and continued loading of the lesion during aggressive physical therapy can worsen the defect. Any ankle sprain patient with persistent symptoms beyond 6–8 weeks requires MRI, not continued conservative care under the assumption of isolated ligament injury.

When to See Dr. Biernacki

See a podiatrist if you have persistent ankle pain more than 6–8 weeks after an ankle sprain, if your ankle catches or locks during activity, if swelling has never fully resolved after an ankle injury, or if you have been told you have chronic ankle instability that is not responding to rehabilitation. Dr. Biernacki coordinates MRI evaluation, provides conservative management protocols, and refers for surgical evaluation when indicated. Book online or call (810) 206-1402 — Howell and Bloomfield Hills, Michigan.

Ankle Cartilage Treatment in Michigan

Osteochondral lesions of the talus cause chronic deep ankle pain that worsens without treatment. Our podiatric surgeons diagnose ankle cartilage injuries with MRI and provide treatment from rehabilitation to arthroscopic cartilage restoration.

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

Clinical References

1. Zengerink M, et al. “Treatment of osteochondral lesions of the talus.” Knee Surgery, Sports Traumatology, Arthroscopy. 2010;18(2):238-246.
2. Chuckpaiwong B, et al. “Outcome after debridement and bone marrow stimulation of osteochondral lesions of the talus.” Foot & Ankle International. 2008;29(4):400-405.
3. Hintermann B, et al. “Arthroscopic findings in patients with chronic ankle instability.” American Journal of Sports Medicine. 2002;30(3):402-409.

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Dr. Tom Biernacki, DPM

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.