How to manage an osteochondral defect in the left ankle?

Question

Hi doctor,

My seven-year-old daughter developed some pain and tenderness in the left ankle before twenty days back. She avoided doing weight-bearing on that side due to pain. She does not have a history of trauma or significant medical history. She has mild eczema and it has improved over some time. We took an MRI and it showed a seven-millimeter osteochondral defect involved in the talar dome with minimal edema. It appeared stable and there was no joint effusion or synovial thickening. We consulted an orthopedic and he suggested avoiding doing excessive physical activities as it can cause a burden to the ankles. We tried to reduce her mobility as much as possible. She is at home now with online classes.

Her discomfort and tenderness in the medial malleolus have been reduced. The mild pain present on the plantar extension has been reduced. We consulted an orthopedician again a couple of days back and he told us that she can do all normal activities except activities like jumping and dancing. He advised me to have a follow-up MRI after six months. She is not taking medications now. I want a second opinion regarding her present condition. Is the recommended management fine or does she need more rest? Do we need to take any other precautions? Does she need to take Vitamin D and calcium in her diet to fasten the healing process? Can she have long-term implications after growing? Can her activity become restricted?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I have gone through your daughter's MRI report (attachment removed to protect patient identity). There is an osteochondral defect in the medial talar dome. These are uncommon lesions seen on MRI (magnetic resonance imaging) due to ankle sprain. This is an early lesion at stage 2 with a partial rent in the cartilage cap, and I would have treated this in six weeks with touch-bearing for balance.

Following this graduated weight-bearing, a full pain-free comfortable weight-bearing is possible. These are usually incidental findings seen in children with pivoting dancing and jumping children without a single trauma. The absence of trauma is uncommon, and it represents multiple minor injuries, and it leads to obstruction of blood supply.

Taking vitamin D supplementation is never harmful, and check the blood level for vitamin D deficiency. You cannot have a long-term issue if the lesion heals without progression. On progression, the problem can move from stage 2 to stage 3 or 4 with a displacement of complete cartilage cap tear and fluid seeping into the junction between the bed and dead bone. So close observation is necessary till the healing is wise with activity restrictions. Repeat MRI after six months or if the symptoms recur.

I hope this information will help you.

Thanks.

,

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

You have made arrangements for non-weight-bearing mobilization at home and you can maintain it. It serves a lot. Change it only when you do not see improvements.

I hope this information will help you.

Thanks.

Answer 3

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, keep her busy and occupied as it can be quite demoralizing for an active child. Also, observe her compliance for non-weight bearing as that may force one to get a cast applied.

I hope this information will help you.

Thanks.

Answer 4

Hi,

Welcome back to icliniq.com.

I understand your concern.

Not sure if osteochondral lesions are bilateral but if there are signs and as a doctor you can sense them then do get the MRI (magnetic resonance imaging) but get a x- ray of both ankles as well. This will have mobility issues and will need to be sure if we can allow weight bearing on the at present unaffected side.

I hope this information will help you.

Thanks.