Ankle Osteochondritis Dissecans
Osteochondritis dissecans (OCD) of the talus (ankle bone) happens when repetitive trauma results in a blood supply injury to the talus and the bone either fails to develop from the cartilage your kid was born with, or the maturing bone dies and therefore softens and collapses. The OCD is comprised of bone and cartilage and can come loose and float around inside the joint. We know that this latter situation can lead to early arthritis.
Most often, there are no symptoms of talus OCD. If there are symptoms, they may include:
- Pain that gets worse with activity and improves with rest.
- Occasional joint locking.
- Occasional swelling.
A physical exam can rule out other problems, but an X-ray will usually secure the diagnosis. An MRI is often done to assess the nature of the OCD and the risk for it to come loose.
Treatment depends on many factors. Some children can be treated conservatively at first. This requires a long period of rest from physical activities, potentially even bracing or casting during this rest period. The length of time away from activities depends on the child’s symptoms and how the follow-up X-rays look.
If a large part of the joint is affected, or if pieces of bone and cartilage have already come loose, surgery should be performed. If there is no improvement in the X-rays or symptoms, surgery is a good backup treatment. Surgery can include removing or fixing loose pieces or stimulating the OCD to heal by drilling it with a small wire. The OCD often requires a long period of rest from sports to allow for healing. The time period for returning to sports is different for each child, but should only be permitted only when the X-ray or MRI shows complete healing.