Grade 2 osteochondral lesion/defect lateral talar dome
Hi, I fell on my lateral ankle while stepping down from a sidewalk into a parking lot while carrying my 70lb child on Feb 1st. I never touched my heal. My ankle was my heal for that moment. Was told I had a sprain. Got patted on the back and sent home.
3 weeks later started PT after I went back to MD at week 2 and couldn't move my foot. Literally foot was so swollen I couldn't believe it but bc I was told it was a "sprain", I just tolerated it. I couldn't bear any weight for almost 2 weeks from injury. To make a long story short, I ended up switching doctors and just rec'd results from 2nd MRI that said I had a 5mm x 6mm x 1mm
grade 2 lesion of lateral talar dome. No wonder I couldn't walk after 14 weeks! It's been a long journey to say the least. Other things were mentioned about thickened ligaments but they were intact and so were tendons.
This doctor put me in a cast and I am supposed to wait for 3 weeks now and then see an ankle surgeon.....Anyone have experience with this type of injury?
I hate the cast and am wondering would there be any harm in just going on to the ankle specialist now? I have 2 small children and it is virtually impossible to do anything (as you all probably know). Been in the cast for a little more than 24 hours! Yay!
What are the chances this will heal and I won't need surgery? My doctor must have mentioned arthroscopy at least 3 or 4 times but said he wouldn't be the one to do the surgery. My doctor is very smart and very well respected. Although I know there are no definitive answers, I would love some feedback since I finally know now why my foot is hurting.
Another thing....it was noted on MRI by radiologist that there is alot of muscle edema and that seemed to be of importance to the doctor saying there was some sort of underlying condition going on for me to have that much swelling (like laterally in calf muscle) but honestly, I didn't even know my calf was swollen. If anything, it is atrophied bc I can barely just now contract it (well, that was before this cast).
Any opinion, would be great.
Thanks.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Welcome to the club you never wanted to be in.
There are a lot of us here with OCDs. Just do a search of threads. I'd see an ankle OS. You don't need any general guy messing around in there. Chances are if doesn't heal the first procedure they'll try is microfracture, especially for grade 2 and the size yours is. Don't freak out about any of the OATS threads... that is down the road only if microfracture doesn't work and for OCD's 10mm or larger.
I had the exact same thing happy by the dr. I saw when I hurt my ankle. Haven't you ever sprained an ankle before? It's just a sprain. blah, blah, blah. 3 mos later I was having some big surgery for tendons, ligaments and ocds by an ankle os. It's frustrating that some drs. just blow us, particularly women , off because they think we are wimps. Glad you are seeing an ankle surgeon.
Oh, the cast. That is actually the first line of defense. I don't think there is any harm in waiting until the time you are supposed to see the ankle dr. That way when you do see him you will already have done PT, casting, etc.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Thanks for the welcome.....I think.!...I just knew something was wrong... I guess I will look around the boards and try not to stress out. BTW, I actually left an ankle specialist (he was Dr #2) and went to Dr #3 who is sports medicine orthopedic surgeon after I got blasted for wearing a boot to an appointment and the "you're foot will NEVER get better if you don't lose the boot" speach.
Dr #3 told me he would find the problem and get me to someone who would repair it. Dr #2, well, I don't really like him. Not much at all.... I respect Dr. #3 bc he listened to me!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
I'm glad you found a dr. who listens to you! That is hard to find. Mine listens to me too, and because of that has found things that didn't show up on the MRI like tendon tears or tons of scar tissue. THe first os I saw didn't even tell me to use crutches!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hi krisj5kids,
Noticed you are in SC as I am! Wondering if we are in the same part of the state and how much you like the doctor who you see. I don't even know who Dr #4 is going to be yet, but would love to be reassured if possible.... Thanks again. And, how is your ankle today???
Last edited by Administrator; 04-12-2011 at 10:06 AM.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Ok, I am in the Columbia area.....but I would drive to Charleston for the BEST doctor.....Who knows. 3 days in this cast and 18 days to go.....
AFter reading up on these boards, I have decided that I just don't want a surgery. How does that sound? I hope I don't have to have one either.
And, I also realize that I thought 15 weeks was bad without a diagnosis and have been reading about people going years without a diagnosis.
Crazy stuff out there in the medical land..... Wish everyone a pain-free night! And recovery!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
YOu have to realize that the people who had great results and early diagnosis aren't hanging around on the boards. They've moved on with their lives. So you are reading the worst of the worst here, although I think we are a great group of mostly women.
If you ever need the name of my dr. let me know. He is very good and listens to you. Getting back to you is another issue. But that is another story on a different thread.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Kris, Thanks for all your help so far. It is so nice to have someone who knows what it is really like. I look forward to keeping in touch via the board . I started reading where you have been posting your story and seems like you have been through so much. I hope that you improve with each day.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hi Michaels1mom
OCD - hoo boy! Regarding suffering from mi diagnosis -
I fell in June 2009, was diagnosed as a mild sprain. We had plans to travel, so went on with the plan. Travelled, rather hopped around in India for 10 weeks. Was in pain when I came back and began my doctor journey.
#1 tried to blow me off, said it is just a sprain etc.,forced him to get an MRI order. It was OCD. Asked me to just limit my movement somewhat.
#2 put me in a boot, and asked me to treat it as a solid cast for 3 weeks.
#3 sent me therapy, worked hard for 3 months. Not much relief from pain. I was going
about my life, walking the dog etc. He prescribed Vicodin and said go about your life! When we really cornered him he suggested microfracture and whatever else that needs to be done in the ankle.
#4 finally hit the spot. She listened to me, studied all the tests and said that I need surgery.
Point of this long story is that keep looking for the ultimate doc- they are out there! I am 2 weeks post op now. Will post more tomorrow after I get my cast.
Now my problem is boredom and dependence on others for little things.
My doc said that some people do opt to not have surgery if they can manage the pain thru therapy. I honestly gave it my best shot but had to go for it.
So keep your chin up and you will feel better soon.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hey OCDVictim. I hope you keep your chin up too. I have never gotten to the point of walking pain free but could walk with the boot with much less pain.
My initial "sprain" was horrible. I couldn't bear weight for almost 2 weeks. I had no range of motion. In fact, right before I got this cast, I was almost able to get a calf contraction. I couldn't even elevate to my toes (calf raises?).. My calf was almost a total flop. I am sure it will be by the time I get out of this cast.
Know what is the worst? My husband is a doctor........He doesn't get it either. I hear the "you have to listen to what the doctors say". That is crap.
You are right. There are good doctors and bad doctors. I just really need a good one.
I have a 6yo and 8yo who need me up and about.
Good luck with your healing.
How big was your leasion? Do you know what type of surgery they did? Where was your lesion located?
I hope you don't stay bored too long. Find something to laugh at. It always seems to help me out a bit! Thanks for your reply. Look forward to hearing about your journey to being healed!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Went for my 2 week checkup. Alls well, they took out the stitches and now I am in a hard cast, non weight bearing. I was eager to get rid of the splint as it was bulky but now I am not so comfy in this much smaller, lighter cast!!! Well it is a cast, what can I expect.
I had a 10mmX10mm lesion on the talus and three completely torn ligaments. Doc cleaned up all the frayed ligaments and tissues, sewed up the ligament(2 of the ligaments were fine). For the lesion she did a microfracture - which is drilling holes in the talus, blood fills the area and body makes scar tissue which will act as cartilage.
According to my doc she has had 85% good to excellent results with this surgery. So I am expecting to be better, but not completely healed.
I tried to convince her to do a stem cell transplant, but she said no and said no other doc will do it. If the doc agrees to do stem cell process, they are probably just experimenting.
I was just tired of living in my big hiking boots 16 hours a day. Hopefully will be able to wear sandals next year. Yay!
Regarding range of motion, last time I was in a boot, I lost the ability to point and flex my foot at will. No brain to muscle connection....scary bit PT resolved it. This time I am sure it will be harder because cast will be on for longer.
I guess I am just venting......to people who get it.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
OCDvictim-
I was going to ask if you could take the boot off, but you are still in a hard cast. My last surgery I went from splint to boot. Boot was to be like a cast, but I could take my leg out and work on just trying to move it around some. It did help with my ROM some. So did the early PT.
Hopefully once you start PT the ROM will comb back. You are on your way to wearing sandals next year!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hey OCDVictim,
I am thinking of you. How is your pain? I mean, is it painful to move your leg in the cast? How long are you going to have to wear the cast?
Are you doing better today with the cast? I am Day #8 in the cast, albeit not recovering from surgery......just giving my ankle a little rest, I imagine. My brain is accepting the cast a little better. I think it just takes some time, at least it did for me.
Sorry to hear your lesion was so big. That is twice the size of mine.
Try to stay positive. You are on the road to recovery!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
One more question, OCD Victim,
Prior to surgery, were you able to walk around without boot? You said that you were leading your normal life (walking dog), but were you able to walk long periods of time or run or jump freely? Or dance? Or exercise? If so, how long did that return after your initial fall in June 2009?
Sorry to ask so many questions... Take your time answering the questions. Feel free to vent.... You have a lot to vent about, that's for sure!
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hi Michaels1mom,
I wish you the best of luck in the cast! My initial injury was over 13 years go. Back then I don't think OCD research is not as advanceds as it is today. I was in a walking cast for 4 weeks and than a brace for several months with limited activity in order for the cartilage to become more solid. The OS back than explained it as the cartilage would never totally heal an there was a chance that one day I could have to have surgery. Up until about a year and half two years ago I had not problem with any pain. I went back to the my OS and he then sent me to the ankle specialist in his group. I had to have mircofracture April 09 and the lesion was 3mm at that time. I had a few good months but in January the pain came back. It was like being back to square one. Just three weeks ago I had to have the OAT's done. In the last 13 months the lesion grew to be 14mm.
But it is possible that you may have some luck with the casting. For those 13 years I was very active marching band, horseback riding, line and ballroom dancing,an hiking all with not problems. Finally Jan of 09 was I was having a lot of pain linedancing and horseback riding. Over the next month or so more an more things began to be more painful. Walking and driving more than 15 mins were excruciating and that is when I had to do something about it. I was very lucky to have and OS who upon returning with problems did not waste anytime in getting the correct test and information to set up the best course of action for me.
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Hi Ahodous,
I'm new, but your story so familiar I wanted to check in. I'm 59, active, fit, healthy but for my 1.5 cm grade 4 ocd ant-lat lesion. Currently recovering from drilling #2. 10 more days non-wt bearing (7 wks total)
16 yrs ago thrown from my horse with lots of height and speed-almost landed on my left foot. Avulsion fx of tip of fibula, complete tear C-F ligament, partial tears of others. MRIs not standard back then, so I was casted for several wks and sent on my way. Took 2 yrs for the ankle to return to normal, and it was good for 9 yrs. Had my first drilling 6 yrs ago because of intermittent catching, pain, inability to bear wt. Did well until 6 mos ago when ankle began to hurt, felt unstable and repeat mri showed return and enlargement of the ocd. Joint space good, though. Surgeon in Baltimore who did first surgery is world-renowned, but was so insistent that I had progressive traumatic arthritis,( even though I had only the one discrete ocd lesion) that for this surgery, I found an ankle OS who, as he put it, was less nihilistic. In between original injury and surgeries, I've worked out, hiked, continued to ride several times/wk and walked around in heels.
Now I'm wondering, given my age, what the future holds and how to best preserve my ankle. It feels pretty good, of course, I'm still nwb, but little swelling, no pain, surgeon pleased. My question is-do ocd lesions invariably progress to arthritis? I've come to terms with no more heels (can't believe I walked around in 3" shoes) but, as a cancer survivor, can't come to terms with not being active. I'm small-boned but muscular with good bone density (98%) for what that's worth. Really hope I'm not destined for replacement or fusion, and want to do everything possible to avoid that fate. Thx
Re: Grade 2 osteochondral lesion/defect lateral talar dome
Lew Schoen at union memorial. Used to be partners with Myerson, but they split, each to head their own depts. If I ever need a transplant, I'd go back to him. Great surgeon.
I respect Dr. #3 bc he listened to me!
But that is another story on a different thread. 
