What is a Talar Dome Injury?

Up to 70% of acute injuries like ankle sprains and fractures result in Talar Dome Lesions. If adequate care is not received, the condition may lead to improper healing, an increased risk of deterioration or softening of the cartilage, and further damage to the talus surface over time.

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Overview

Talar Dome Injuries involve the the damage and injury of the cartilage and underlying bone in the talus, which is a bone in the ankle joint. The talus bone, which is the part of the ankle that enables smooth movement, has a dome-shaped top covered in a layer of cartilage. An injury can cause damage to this area and the underlying subchondral bone, resulting in a talar dome injury typically referred to as an osteochondral lesion or defect. While injuries commonly present on the inside or medial aspect of the ankle, the outer ankle can be affected as well.

Causes of Talar Dome Injuries

The cause of a Talar Dome injury may be due to major traumatic events or repetitive stress injuries such as:

  • Trauma such as a severe ankle sprain, fracture or other acute injuries
  • Repetitive stress or micro-trauma
  • Degenerative conditions like osteoarthritis can cause wear and tear on the cartilage

Continuous trauma over a prolonged period caused by unaddressed or undetected biomechanical issues can result in further injury to the talar dome.
Risk factors such as hypermobility or having a low-arch foot type (flatfoot), may also lead to injuries to the talar bone, also medically known as osteochondral lesions

Symptoms

The symptoms of Talar Dome Lesions often develop gradually over time and may not be immediately noticeable, leading to misdiagnosis.

As the condition progresses, symptoms may worsen, impacting your lifestyle and limit daily activities, particularly for those with an active routine.

If left unaddressed, it can lead to osteoarthritis and complications such as structural alterations in the ankle joint, persistent and recurring pain accompanies by secondary nerve pain and restricted joint mobility.

We recommend seeking proper solutions from healthcare providers to prevent the onset of further debilitating symptoms which include:

  • Chronic pain in the ankle
  • Ankle swelling
  • Sensations of weakness and locking of the ankle joint
  • Subchondral cysts

Effects of Talar Dome Injuries

  • Lifestyle restrictions
  • Impact on daily activities, especially for individuals who does sports
  • Osteoarthritic changes of the ankle joint
  • Chronic pain
  • Limitations in ankle joint range of motion

Diagnosis

X-rays or an MRI scan of the ankle may be performed to diagnose and determine the size, extent, and stability of the talar dome lesion or injury. The application of non-invasive podiatric intervention depends on several factors:

  • Age
  • Lesion size, extent, and stability
  • Activity levels of patient
  • Underlying biomechanical variances

Managing Talar Dome Injury

Non-invasive therapies such as Extracorporeal Magnetotransduction Therapy (EMTT) and focal Extracorporeal Shockwave therapy (ESWT), offer conservative and effective options for addressing talar dome lesions. These therapies work by reducing swelling in the bone and soft tissues, promoting tissue vascularisation and healing on a cellular level.

During therapy, a protective cast may be utilised to protect and immobilise the ankle, which can promote faster recovery.

Subsequently, the integration of offloading devices such as customised ankle foot orthotics (AFOs), can further increase stability for the ankles, preventing recurring injuries and over-rotation of the ankle.

Regular follow-up appointments with your podiatrist are vital to ensure monitor the healing process and address any further concerns.

In cases where non-invasive approaches are insufficient, or the lesion is severe, surgical intervention may be considered, and a thorough discussion with a podiatrist can help determine its suitability. If you are experiencing persistent ankle pain, it is advised to seek prompt medical attention from a healthcare professional or a podiatrist for accurate diagnosis and advice.

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241540/

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Common Symptoms

Chronic pain felt deep within the ankle
Swelling
Weakness
Locking of the ankle joint
Formation of subchondral cysts

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An ankle specialist, such as a podiatrist, will be able to perform a thorough foot assessment using diagnostic tools, such as a musculoskeletal diagnostic ultrasound to determine the source of your ankle pain. If surgery is required, your podiatrist will refer you to a trusted foot and ankle doctor for surgical solutions.

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