Persistent pain around your ankle could be due to an injury of your talar dome. The top of the talus bone, which forms part of the ankle joint, is dome shaped and covered in a layer of cartilage. With an injury to this area, damage to the cartilage and even the underlying bone can occur. This is typically referred to as an osteochondral lesion or defect. It more commonly presents on the inside or medial aspect of the ankle but can affect the outer ankle too.
The cause of a talar dome injury may be due to a major traumatic event such as a severe ankle sprain or fracture. If the ankle is not treated correctly after such injury, then the cartilage may fail to heal properly, leading to it breaking down or softening. This will develop into further damage of the surface of the talus. Repetitive micro-trauma may be another cause of the lesion. Continuous minor injury over a prolonged period can be a result of unaddressed or unnoticed biomechanical issues and often affects both ankles.
In most cases, unless the injury is severe, symptoms will develop gradually over time and present as chronic pain felt deep within the ankle, incidents of unprompted swelling, sensations of weakness and locking of the ankle joint. Subchondral cysts may also begin to form. Typically, symptoms occur in episodes which can lead to easy misdiagnosis of this condition.
If incorrectly or insufficiently treated, this condition can lead to lifestyle restrictions for sufferers and impact daily activities, especially for those who partake in sports. Leaving a talar dome injury untreated commonly results in osteoarthritis changes of the ankle joint, chronic pain and limitations in joint range of motion. This presents as a more challenging condition to treat and can often only be addressed by surgical intervention.
While your individual treatment will depend on the severity of the damage, treatment plans will include therapies to reduce the swelling of the bone and soft tissue as well as the use of offloading devices such as customised foot orthotics to prevent the injury from worsening.