Osteochondral Lesions of the Talus (Talar Cartilage Injuries)

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Osteochondral Lesions of the Talus (Talar Cartilage Injuries)

A clear, evidence-based patient guide to osteochondral lesions of the talus (talar cartilage injuries) — written by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at UCL. Mr Welck treats NHS and private patients across London and North London, with particular expertise in cartilage-preserving ankle surgery, weight-bearing CT and sports injuries of the foot and ankle.

At a Glance: Osteochondral Lesions of the Talus

ConditionOsteochondral lesion of the talus (OLT) — damage to the cartilage and underlying bone of the talus (the lower bone of the ankle joint).
Also Known AsTalar dome lesion, osteochondral defect (OCD) of the talus, osteochondritis dissecans of the talus, talar cartilage injury.
Most Common CauseAnkle injury — around 3 in 4 lesions follow an ankle sprain or fracture. A single bad sprain can be enough.
Typical PatientYounger, active adults and sporty people with deep ankle pain that carries on for months after a sprain.
DiagnosisWeight-bearing X-ray, MRI, and CT / weight-bearing CT (WBCT).
Non-Surgical CareRest, changing your activities, physiotherapy, a period of putting less weight through the ankle, bracing and anti-inflammatory medicines.
Surgical OptionsAnkle arthroscopy (keyhole) with bone marrow stimulation, fragment fixation, retrograde drilling, and cartilage transplantation / restoration.
Success RateAbout 8 in 10 people do well after keyhole surgery (bone marrow stimulation) for smaller areas of damage.
SpecialistMr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

01

What Is an Osteochondral Lesion of the Talus?

An osteochondral lesion of the talus (OLT) is an area of damage to the smooth cartilage and the bone directly beneath it on the talus — the lower bone of the ankle joint that sits between your shin bone (tibia) and your heel bone. The top of the talus is covered with cartilage. This lets the ankle move smoothly and cushions it every time you take a step.

If this cartilage and the bone underneath it are injured, the surface can crack, soften, form a blister-like swelling (a cyst), or break away as a loose piece. People often describe a deep ankle pain that is hard to pinpoint and carries on long after a sprain has otherwise settled. You may also see the condition called a talar dome lesion, an osteochondral defect (OCD), or osteochondritis dissecans of the talus — these all mean the same thing: damage to the cartilage and to the bone underneath it.

These injuries often affect younger, active people, and without treatment they can slowly lead to ankle arthritis. That is why early specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — gives you the most options for saving your own joint.

02

How Common Is It?

Osteochondral lesions are common after ankle trauma. Studies report that up to 70% of ankle sprains and fractures involve some damage to the cartilage or the bone beneath it, and about half of bad ankle sprains damage the cartilage. With more than two million ankle sprains occurring each year in countries such as the United States, talar cartilage injuries are far from rare — they are simply missed, because they can hide behind what looks like an ordinary sprain.

Most start to cause symptoms in active adults and athletes, usually 6 to 12 months after the original injury. About 15% of people have damage in both ankles, and not all of it is painful — some is found by chance on a scan done for another reason.

03

What Causes an Osteochondral Lesion of the Talus?

Most are caused by an injury, but a number of other things can play a part:

  • Ankle sprains (most common): rolling your ankle can scrape or squash the top of the talus. Damage on the outer side of the ankle tends to be shallow and thin; damage on the inner side tends to be deeper and cup-shaped.
  • Ankle fractures: cartilage damage is very common with a broken ankle, especially a high ankle injury, where the two shin bones are joined together.
  • Repetitive microtrauma: repeated sprains and an ankle that feels unstable expose the cartilage to lots of small injuries.
  • Poor blood supply: the talus has a delicate blood supply, so areas that receive less blood may be easier to injure, or may not heal.
  • Non-traumatic factors: a small number of people cannot remember any injury at all. A family tendency, previous steroid use and certain medical conditions may all play a part.
  • Malalignment: a flat foot, a high-arched foot, or a fracture that healed in a poor position can put extra load on one part of the ankle, causing damage or making it come back.

If it is not treated, the damage can slowly spread to more of the joint — a process sometimes called the ankle cartilage cascade — and can eventually lead to ankle arthritis caused by the original injury.

04

What Are the Symptoms?

Symptoms can be very mild and are easily mistaken for a sprain that is slow to heal. Common ones include:

  • Deep pain felt inside the ankle joint, worse when you are on your feet and better with rest
  • Pain that carries on 6–12 months after an ankle sprain that never fully settled
  • Swelling around the ankle, often after activity
  • Stiffness, and not being able to move the ankle as far as usual
  • Catching, locking or clicking — this can mean there is a loose or unstable piece inside the joint
  • A feeling of giving way or instability
  • Difficulty with sport, running and uneven ground

Some cause few symptoms and are found by chance. Because the signs can be vague, it is important to compare with your other ankle and to have the right scans — which is why seeing a specialist matters.

05

What Investigations Might You Need?

Diagnosis is based on your story, a careful examination and modern scans. Mr Welck may recommend:

  • Weight-bearing X-rays: the first test. It checks the shape of your ankle and looks for larger areas of damage, loose pieces and other causes of pain. Smaller damage often does not show up, so a normal X-ray does not rule it out.
  • MRI scan: very good at picking up cartilage damage, bone bruising and injuries to nearby ligaments or tendons. It is excellent at finding the damage, although swelling around it can make it look slightly bigger than it really is.
  • CT scan: gives the clearest picture of the bone itself — how big and deep the damage is, whether there is a cyst underneath, and whether a loose piece can be fixed back. It is very helpful for planning surgery.
  • Weight-bearing CT (WBCT): a modern, low-dose 3D scan taken while you stand. It shows what the joint really looks like under your body weight, and the overall shape of your foot and ankle. This is a particular area of expertise for Mr Welck and is now routine at specialist centres, including the RNOH.

The damage is described by its size, where it sits on the talus (using a nine-square map) and its shape — for example a cyst, a crater or a loose piece. These details guide which treatment is most likely to work.

06

Non-Surgical Treatment Options

Guidelines recommend that almost everyone with symptoms tries 3 to 6 months of treatment without surgery first, especially if the injury is recent and nothing has moved out of place. Some people avoid surgery altogether. Treatment without surgery may include:

  • Changing your activities, and a period of putting less weight through the ankle, sometimes in a boot or cast
  • Physiotherapy to rebuild strength, balance and control — especially if your ankle feels unstable
  • A brace or ankle support to take load off the joint and protect it
  • Anti-inflammatory medicines (tablets or gels) for pain and swelling
  • Injections in selected cases, such as PRP (platelet-rich plasma)
  • Advice on weight and footwear, to reduce the load going through the joint

Treatment without surgery gives real, lasting improvement for some people — but not for everyone. Recent research shows that pain when walking improves on average, but only about 4 in 10 people improve enough to really notice it, and the damage itself usually stays the same size. If your symptoms carry on, it is perfectly reasonable to move on to surgery, and waiting does not make the result any worse.

07

Surgical Options for Osteochondral Lesions

If treatment without surgery does not work, or a piece has come loose or moved out of place, surgery is considered. Wherever possible this is done by keyhole surgery, which means smaller cuts, less scarring and a faster recovery. The right operation is different for everyone. It depends on how big and deep the damage is, where it sits and what type it is, as well as your age, how active you are and the shape of your foot. Keyhole surgery for this problem has a low complication rate of about 5%.

Ankle Arthroscopy & Bone Marrow Stimulation (Microfracture)

This is the most commonly used treatment for smaller areas of damage (usually under 15 mm) that have not been operated on before. Through two small cuts, the loose cartilage and damaged bone are cleaned away and tiny holes are made in the bone underneath (microfracture or drilling). This lets your body’s own healing cells come through and fill the gap with new repair cartilage. About 8 in 10 people do well, and more than 80% have not needed an ankle implant 10 years later. Nowadays we encourage you to start putting some weight through the ankle early, with protection.

Fragment Fixation

Where the damage is a good-sized piece of bone with healthy cartilage on top — especially a recent piece that has moved out of place — it is often best to save it and fix it back in place with small screws, pins or dissolvable implants, rather than remove it. Keeping your own natural cartilage gives excellent, long-lasting results, and about 8 in 10 people continue to do well over the long term.

Retrograde Drilling

This is used where there is a cyst underneath a cartilage surface that is still intact. The surgeon drills up to the damaged area from below, without breaking through the healthy cartilage on top, to encourage healing. The cyst can be filled with bone graft if needed. About 8 in 10 people do well.

Cartilage Transplantation & Restoration (for larger or failed lesions)

Larger areas of damage (usually over 15 mm), cysts, or damage that has not settled after previous surgery may need a cartilage restoration operation. Options include:

  • Autologous matrix-induced chondrogenesis (AMIC): the tiny-holes technique is combined with a collagen patch, which acts as a scaffold to help better-quality repair tissue form. It works well for larger areas of damage, with good results lasting up to 5 years.
  • Osteochondral autograft / allograft transplantation (OATS / mosaicplasty): small plugs of bone and cartilage are moved in to resurface the damaged area, using either your own tissue or donor tissue. This is used for large or cystic damage.
  • Autologous chondrocyte implantation (ACI / MACI): a two-stage operation in which your own cartilage cells are grown in a laboratory and then put back in to rebuild a surface close to natural cartilage.

If the damage is very large, or arthritis is already advanced, operations such as total ankle replacement or ankle fusion may occasionally be discussed. Mr Welck will talk you through all of the options and agree a plan that suits you.

08

Recovery & Post-Operative Regime

Recovery depends a great deal on which operation you have. Mr Welck and the physiotherapy team will confirm your own plan, but the general guide below gives a realistic idea of what to expect. The aim is to protect the healing cartilage at first, then slowly rebuild movement, strength and confidence.

The First Few Days

Most keyhole operations are done as day surgery, so you go home the same day. Keep your foot up as much as you can for the first two to three days to keep the swelling down, take any pain relief you have been given, and keep the dressings clean and dry. You will usually be given crutches and, depending on the operation, a supportive bandage, boot or cast.

Weight-Bearing

This is the part that varies most from one operation to another:

  • After bone marrow stimulation (microfracture): we now encourage you to start putting some weight through the ankle early, with protection. You will usually use crutches with a bandage or boot for the first two weeks, then build up the weight you put through it as comfort allows. Experts around the world now agree that this earlier approach works as well as — or better than — staying off the foot for a long time.
  • After fragment fixation or open procedures: a longer protected period is usual — often around 4 to 6 weeks in a cast with no weight on the foot, then 4 to 6 weeks in a walking boot while the piece of bone knits back together.
  • After retrograde drilling: a short protected period, usually 2 to 4 weeks, then a gradual return to putting weight through the ankle.
  • After cartilage transplantation / restoration: you follow a slower, step-by-step programme of protected weight-bearing, to give the new tissue time to mature.

Physiotherapy & Rehabilitation

Physiotherapy is an essential part of recovery. A typical programme moves through these stages:

  • Early stage: settling the swelling and gently getting your movement back.
  • Middle stage: retraining the small muscles that steady the foot and ankle, and rebuilding your balance, so that you use the ankle properly instead of putting strain on other joints.
  • Later stage: gradually building up the strength of your ankle and calf.
  • Return-to-sport stage: training for your own sport once your strength and control allow, so you can get back to it safely.

Getting Back to Normal Life

Everyone is different, but as a rough guide: desk work is often possible within a couple of weeks, once you are comfortable; you can drive again once you can put weight through the ankle, control the car safely and are out of a boot or cast; and gentler activity, such as cycling and swimming, usually comes back before running or impact sport. A full return to sport after cartilage surgery usually takes 6 months or longer, and the repair can carry on maturing for more than a year.

You will see Mr Welck regularly throughout your recovery, sometimes with a repeat scan to check that things are healing. If anything does not feel right — pain that is getting worse, redness, a temperature, or a sudden change — please contact the practice straight away.

09

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading tertiary orthopaedic centres — and Honorary Associate Clinical Professor at UCL. He treats problems of the foot and ankle only.

He has a specialist interest in total ankle replacement, complex foot and ankle reconstruction, revision surgery, sports injuries and joint-preserving cartilage surgery, and is a recognised expert in weight-bearing CT (WBCT) and 3D-printed, made-to-measure surgical guides for complex deformity. He has written more than 50 published research papers and has completed two specialist fellowships, including training abroad.

Patients are seen across London and North London, with quick access to MRI, weight-bearing CT and a full team of specialists. Whether you have straightforward damage after a sprain or a complex problem that has not settled with previous treatment, every option is discussed and a plan is agreed with you.

10

Frequently Asked Questions

What is an osteochondral lesion of the talus?

It is an area of damaged cartilage and underlying bone on the talus — the lower bone of the ankle joint. It is most often caused by an ankle sprain or fracture, and it usually causes deep ankle pain that carries on after the original injury has settled.

Is an osteochondral lesion the same as ankle arthritis?

No, but they are related. An osteochondral lesion is damage in one small area of cartilage and bone, whereas arthritis is more widespread wear across the whole joint. If it is left untreated it can get worse over time and contribute to ankle arthritis, which is why early assessment matters.

Can an osteochondral lesion of the talus heal on its own?

Some smaller, recent injuries where nothing has moved out of place can settle without surgery, which is why 3 to 6 months of non-surgical treatment is usually recommended first. However, damaged cartilage does not heal well on its own, and some people do need surgery to improve their symptoms.

Do I need surgery for a talar cartilage injury?

Not always. Many people get better without an operation. Surgery is considered when non-surgical treatment has not worked after several months, or when a piece has come loose or moved out of place. The best keyhole options give good results in around 8 in 10 patients.

How long is the recovery after keyhole surgery for an OLT?

After keyhole bone marrow stimulation, many people use crutches with a boot for the first couple of weeks and then build up the weight they put through the ankle. Fixing a fragment, or cartilage transplant surgery, needs a longer protected period. A full return to sport after cartilage procedures often takes 6 months or more.

Is the surgery done by keyhole?

Wherever it is possible, yes. Keyhole surgery means smaller cuts, less scarring and a faster recovery, with a low risk of complications. Larger or more complex damage occasionally needs open surgery or a cartilage transplant.

Will an osteochondral lesion cause arthritis if I ignore it?

It can. Damage that does not settle may slowly affect more of the joint over time and increase the risk of ankle arthritis. Early specialist assessment gives you the most options for saving your own joint.

I sprained my ankle months ago and it still hurts — could this be the cause?

Yes. This is one of the most commonly missed reasons for an ankle sprain that will not settle. If deep ankle pain carries on beyond a few months, it is worth seeing a specialist and having the right scans (an MRI, and often a CT or weight-bearing CT).

Where can I see Mr Matthew Welck for an osteochondral lesion of the talus in London?

Mr Welck consults across London and North London. NHS patients are seen at the Royal National Orthopaedic Hospital (RNOH) Stanmore. Private appointments can be booked on 07547 395270 or by emailing secretary@matthewwelck.com.

11

Book a Consultation

If you have deep ankle pain that has not settled after a sprain, or you have been told you have a talar cartilage injury or osteochondral lesion, seeing a specialist can make a real difference to how well you do.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon. Seeing an expert early gives you the most options for saving your own joint, and the best long-term result.

This page is for information only. It does not replace personalised medical advice. Please arrange a consultation for advice tailored to your circumstances.


Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated September 2026

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