Outpatient Physical Therapy Following Surgical Debridement of
Osteochondritis Dissecans of the Talar Dome: A Case Report
Angela Serrani, BS, DPT Student
University of New England
•Exercises: Gait training, weight shifting, BAPS
board, eccentric calf lowering, balance practice,
LE strengthening and stretching
•Manual: Joint mobilizations and soft tissue
mobilization
•Modalities: ice, vasopneumatic compression
•Tape techniques: as pictured below
Osteochondritis Dissecans (OCD):
•Alteration of subchondral bone with disruption of
the adjacent articular cartilage
1
•Cause unknown, hypotheses include repetitive
trauma and or non-traumatic disruption of
subchondral blood supply
1
•Suspected chondral injury with up to 50% of ankle
instability episodes
1
Treatment Options:
•Goals: relieve symptoms and improve function
2
•Non-surgical: rest, immobilization, NSAIDS
2
•Surgical: excision of lesion, excision with
cutterage and/or microfracturing, filling the defect
with bone graft, antegrade transmelleolar drilling,
retrograde drilling, fixation, osteochondral
transplantation, and autologous chondrocyte
implantation
2
•Minimal reduction in ankle swelling
•Small but statistically significant improvement in
LEFS score
•Increased inflammation starting at visit 6
•Patient referred to orthopedic specialist for
imaging of suspected tibialis posterior rupture
Interventions
•27 year old female who lives on a farm with her
husband and 4 young children
•History of frequent ankle sprains
•Early March 2014: “turned the wrong way” while
bowling leading to increased right ankle pain,
instability, and abnormal gait pattern
•Orthopedic surgeon diagnoses OCD of the talus
•April 2014: surgical debridement of OCD lesion
•Early May 2014: referred to physical therapy for
post surgical care, evaluation, and treatment
To describe physical therapy treatment and
outcomes for a patient following surgical
debridement of OCD of the talar dome.
The patient’s suspected tibialis posterior injury is
likely the reason for her lack of progress in PT and
her continued state of inflammation. Inability to
weight bear with a normal foot position remained a
limiting factor during exercises. PT was placed on
hold and will likely resume once the secondary
injury is addressed by an orthopedist.
References
1. Talusan PG, Milewski MD, Toy JO, Wall EJ. Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clin Sports Med.
2014;33(2):267-84.
2. Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. Int Orthop. 2013;37(9):1697-706.
3. Zwingmann J, Südkamp NP, Schmal H, Niemeyer P. Surgical treatment of osteochondritis dissecans of the talus: a systematic review.
Arch Orthop Trauma Surg. 2012;132(9):1241-50.
Figure 1. Radiograph with arrow pointing to a typical osteochondral lesion of
the talar dome in a similar location to the patient’s lesion
http://www.aafp.org/afp/2002/0901/p785.html
Examination
Clinical outcome of “good and excellent” in 79% of
patients treated with surgical correction of OCD
3
Initial Visit 19
Lower Extremity
Functional Scale score
13/80 27/80
Right ankle active
range of motion
Dorisflexion -15
o
-7
o
Plantarflexion 46
o
45
o
Inversion 18
o
10
o
Eversion 6
o
18
o
Right ankle
circumferential
measurements
Figure 8 52 cm 51.5 cm
Malleoli 27 cm 26.75 cm
Forefoot 23 cm 22 cm
Metatarsal heads 23.5 cm 23 cm
Right ankle strength
(MMT)
Dorsiflexion 3-/5 5/5
Plantarflexion 3-/5 5/5
Inversion Not Tested 3+/5
Eversion Not Tested 4+/5
Figure 3a. Photo of Rock tape
interwoven fans to reduce swelling
Figure 4. Diagram showing the location of the tibialis posterior, suspected to
be ruptured, and the commonly seen change in foot and ankle position with
dysfunction of that muscle. http://www.hss.edu/conditions_posterior-tibial-tendon-insufficiency-
overview.asp
Background
Purpose
Outcomes
Prognosis
Case Description
Discussion
Figure 2. Diagram of home exercises: 2 sessions of all exercises per day;
Ankle alphabets 2 x per session; Toe curl 20 x per set, 2 sets per session;
Both calf stretches held for 3 x 30 s.
Figure 3b. Low-Dye taping for arch
support http://www.running-physio.com/cphp2/
