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What are talar dome lesions?
Symptoms
Causes
Diagnosis
Treatment
Prevention
FAQs

Talar dome lesions cause notable pain at the ankle, and can make it difficult to walk and bear weight on the affected foot. They can also be harder to diagnose due to the range of injuries that can occur in or around the ankle, as well as their tendency to be asymptomatic for non-severe injuries. This makes working with an experienced podiatrist very important.

What Are Talar Dome Lesions?

Talar dome lesions are injuries that affect the smooth, dome-like surface of a bone called the talus within the ankle joint - hence the term talar dome. These lesions involve damage to both the cartilage covering the talar dome as well as the underlying bone. 

The talus sits right above the heel bone (calcaneus), and right below the shin bone (tibia). It plays a crucial role in ankle movement and hence all walking and physical activity, meaning that when an injury is present, it can be quite disruptive to your everyday life and daily activities.

Talar dome lesions are classified as osteochondral lesions because they affect both the bone (‘osteo’) and the cartilage (‘chondral’). 

Symptoms Of Talar Dome Lesions

The nature of talar dome injuries mean that if the injury is mild, it is not uncommon for a person to be asymptomatic for months, if not years. At times, it is only when our podiatrists order imaging studies for a different issue around the ankle that a talar dome lesion is uncovered. If the injury is severe, however, the symptoms can quickly become intense and debilitating. Symptoms can include:

• Pain at the front or inside of the ankle, which may radiate around the sides of the ankle
  
• Pain that is worsened with physical activity, particularly running, walking and jumping
  
• Difficulty bearing weight on the affected foot
  
• Limping when walking
  
• Clicking or popping sounds from within the ankle
  
• A feeling of locking or catching during ankle movement
  
• Swelling around the ankle joint
  
• Limited movement around the ankle joint
  
• Ankle instability
  

Causes Of Talar Dome Lesions

Talar dome lesions can develop as a result of:

• Acute trauma
  

Talar dome injuries can result from sudden and forceful impacts on the ankle joint, such as those experienced during sports-related incidents, falls, or accidents. Ankle sprains are a common example, where the ankle twists or rolls forcefully, causing the talus bone to jam against the tibia (shin bone) and fibula. This abrupt and excessive movement can damage the articular cartilage covering the talar dome, leading to a lesion. Similarly, a direct blow to the ankle, such as in a fall or collision, can cause compression or shearing forces on the talus, resulting in injury to the talar dome. 

• Repetitive stress
  

Repetitively stressing, overusing or overloading your ankle joint can also contribute to talar dome injuries. Activities that involve repetitive impact, twisting motions, or excessive loading of the ankle, such as running, jumping, or dancing, can gradually wear down the articular cartilage of the talar dome. Over time, the cumulative effect of repetitive stress can lead to degeneration of the cartilage, resulting in the development of talar dome lesions. Poor biomechanics, inadequate footwear, and training errors may exacerbate the risk of talar dome injuries caused by repetitive stress. 

• Underlying joint conditions
  

Talar dome injuries may also occur in the presence of underlying joint conditions that affect the structure and function of the ankle joint. Conditions such as osteoarthritis, rheumatoid arthritis, or osteochondritis dissecans can predispose the talar dome to injury by causing degeneration of the articular cartilage or altering the joint mechanics. 

In osteoarthritis, for example, the gradual breakdown of cartilage within the ankle joint can expose the underlying bone of the talar dome, making it more susceptible to damage from mechanical stress. Similarly, inflammatory conditions like rheumatoid arthritis can lead to inflammation and erosion of the articular cartilage, weakening the talar dome and increasing the risk of injury. 

Diagnosing Talar Dome Injuries

Your podiatrist will be able to diagnose a talar dome injury based on your symptoms, injury history, medical history, and a thorough physical assessment of your foot and ankle. An important part of the diagnosis process is ruling out other potential causes of ankle pain that share similar symptoms, as well as identifying situations where multiple injuries may have occurred at once - so a talar dome injury together with an ankle sprain, for example.

If needed, to confirm your diagnosis or assess the severity of your injury (or involvement of other structures), we may refer you for medical imaging via an x-ray, CT scan or MRI. MRI’s may be preferred due to their ability to visualise the integrity of the articular cartilage, as well as detecting the subtle changes associated with talar dome lesions.

Treatment For Talar Dome Injuries

Home treatment

While you’re at home, we recommend resting your foot as much as possible, modifying activities that produce pain, applying ice safely to the ankle, and using non-steroidal anti-inflammatory medication (where appropriate and safe to do so as deemed by your doctor) to help best manage your painful symptoms.

Podiatrist treatment

When treating talar dome lesions professionally, our podiatrists want to help alleviate your symptoms, promote healing, and restore optimal function to the ankle joint so you can stay happy and active on your feet for the long-term. While surgical intervention may be necessary in certain cases, like when there are loose pieces of cartilage or bone, non-operative treatments are often recommended as the first line of management for talar dome lesions. Your podiatrist will run through the best recommended treatment options for your specific circumstances, which may include:

• Immobilisation or offloading with a moon boot, brace, splint to best protect the ankle joint and facilitate recovery.
  
• Custom ankle-foot orthotics (AFOs) to help with stability and some offloading, combining the benefits of a boot with an orthotic (below).
  
• Custom foot orthotics to carefully and concisely adjust the foot and ankle biomechanics while adding the right support and stability to help facilitate healing and repair while minimising your symptoms.
  
• Physical therapy via targeted exercises that help strengthen the muscles surrounding the ankle joint, improve joint stability, and enhance range of motion. 
  
• Footwear recommendations to ensure that your shoes are best supporting your recovery, and not hindering your progress.
  
• Footwear modifications - in some cases, modifying your existing footwear may be very beneficial in helping to support your feet and gait while optimising your movement. Our clinic is very unique in having an in-house footwear modification service and knowledge around a range of possible modifications to optimise both your gait and your quality of life. 
  
• MLS laser: MLS is an effective form of pain relief that works in many ways - from helping minimise your pain levels, to supporting the repair and regeneration process, to optimising your recovery. 
  

Operative Treatment Options

Operative treatment options for talar dome lesions include arthroscopic debridement, microfracture, osteochondral autograft transplantation (OAT), and osteotomy. Arthroscopic debridement involves removing damaged or loose cartilage fragments from the talar dome to improve joint function and alleviate pain. Microfracture surgery stimulates the growth of new cartilage by creating small holes in the subchondral bone, promoting the formation of fibrocartilage to fill in the defect. Osteochondral autograft transplantation (OAT) involves transferring healthy cartilage and bone tissue from a non-weight-bearing area to the damaged talar dome to promote healing and restore joint integrity. In cases where malalignment or instability of the ankle joint contributes to talar dome lesions, corrective osteotomy may be performed to realign the bones and improve joint mechanics. These surgical procedures aim to address underlying structural issues, promote tissue repair, and restore optimal function to the ankle joint, particularly in cases where conservative measures have failed to provide adequate relief.

Preventing Talar Dome Lesions

Preventing talar dome lesions involves a combination of lifestyle modifications, proper footwear, and injury prevention strategies. Maintaining overall joint health through regular exercise and weight management can help reduce the risk of developing talar dome lesions. It's essential to engage in activities that promote ankle strength, stability, and flexibility, such as stretching exercises, strength training, and balance exercises. 

Avoiding high-impact activities or repetitive movements that place excessive stress on the ankle joint can also help prevent talar dome injuries. When participating in sports or physical activities, wearing appropriate footwear with good cushioning, support, and traction can help reduce the risk of ankle injuries. Additionally, using orthotic inserts or ankle braces may provide added support and stability to the ankle joint, particularly for individuals with underlying biomechanical issues or previous ankle injuries. 

Practising proper technique, warming up before exercise, and gradually increasing the intensity and duration of physical activity can further minimise the risk of talar dome lesions. Regularly monitoring and addressing any signs of ankle pain, swelling, or instability can help identify and address potential issues before they progress into more serious injuries. Overall, adopting a proactive approach to ankle health and injury prevention is key to reducing the likelihood of developing talar dome lesions and maintaining optimal joint function.

Frequently Asked Questions (FAQs)

Can talar dome lesions heal on their own?

In mild cases, talar dome lesions may have the potential to heal on their own with conservative measures such as rest, activity modification, and physical therapy. However, the ability of lesions to heal spontaneously largely depends on factors such as the size, location, and severity of the lesion, as well as individual factors like age and overall joint health. More severe or chronic lesions may not heal adequately without intervention and may require surgical treatment to promote healing and restore joint function.

Is surgery necessary for talar dome lesions?

While surgery is not always necessary for talar dome lesions, it may be recommended in cases where conservative treatments fail to provide adequate relief or when the lesion is severe or unstable. Non-operative treatments such as rest, physical therapy, and pain management are typically attempted first to alleviate symptoms and promote healing. However, if conservative measures are unsuccessful, surgical options such as arthroscopic debridement, microfracture, osteochondral autograft transplantation (OAT), or osteotomy may be considered to address the underlying pathology and restore joint function.

What is the recovery time after treatment for talar dome lesions?

The recovery time for talar dome lesions varies depending on factors such as the severity of the lesion, the chosen treatment approach, and individual factors like age and overall health. Generally, recovery from non-operative treatments such as rest and physical therapy may take several weeks to months, with gradual improvement in symptoms and function over time. Surgical interventions typically have longer recovery periods, with rehabilitation protocols tailored to the specific procedure performed. Adherence to post-operative instructions and rehabilitation exercises is essential for optimising outcomes and minimising the risk of complications.

Are there any long-term complications associated with untreated talar dome lesions?

Yes, untreated or inadequately managed talar dome lesions can lead to various long-term complications, including chronic pain, instability, joint degeneration, and impaired mobility. Without proper treatment, talar dome lesions may worsen over time, resulting in persistent symptoms and functional limitations. Chronic pain and instability in the ankle joint can significantly impact daily activities and quality of life, while joint degeneration may progress to more severe forms of arthritis, requiring more extensive interventions in the future. Early diagnosis and appropriate management of talar dome lesions are essential in preventing long-term complications and preserving joint health.