Diagnosis

 OSTEOCHONDRITIS DISSECANS OF THE TALUS


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 Definition Osteochondritis dissecans (OCD) is an unusual but important disorder that can lead to breaking down of the cartilage that covers bone.
Details Osteochondritis dissecans is a disorder that can affect the talus bone of the ankle or other bones such as the femur in the knee and the capitellum in the elbow. It is not completely understood but it can have a profound effect on joint function if it is severe. Usually a flap of surface cartilage breaks down because it is not supported by the underlying bone in this disorder. If osteochondritis is not treated early, arthritis and significant pain can occur.
Causes The cause of osteochondritis dissecans of the talus is controversial. Some physicians believe it is the result of an injury or trauma to the ankle. Others contend that the cause is poor blood supply to the bone and that the disorder can occur without any injury.
Diagnosis The diagnosis of osteochondritis dissecans of the talus is made by a history of pain around the ankle that is sometimes associated with clicking or catching. It can be a dull toothache like pain or a sharp stabbing pain. The patient may or may not describe a history of an injury to the ankle. X-rays are used to initially evaluate the talus bone of the ankle. Typically, however, a CT scan or an MRI is needed to confirm the diagnosis and evaluate the extent of the problem.
Treatment Nonoperative: This type of treatment is indicated for patients who do not have any loose pieces of cartilage or bone in the ankle. Nonoperative treatment consists of rest from any impact type activities, casting, and a progressive rehabilitation program. Anti-inflammatory medication and bracing of the ankle during activity may also be required.

Operative: If the patient has loose bone or cartilage in the ankle by clinical examination or as seen on a CT or MRI, surgical intervention is required. Again, this form of treatment is controversial. Options for operative treatment include: drilling of the involved area of bone, fixation of the loose bone/cartilage, and removal of the loose pieces of bone/cartilage. Grafting of cartilage and transplanation of cartilage are other possible forms of surgery for this disorder.

Clearly, this is an unusual problem and the treatment plan should be individualized.
Prevention

Maintaining excellent balance, coordination and strength of the foot and ankle may prevent some forms of osteochondritis dissecans of the talus.


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