By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
January 28, 2020
- A cartilage injury of the talus bone can happen after a prior ankle sprain
- If several months have gone by and you’re having pain on the side of the ankle opposite your sprain it could be from a cartilage injury
- Return to sports after any type of talus cartilage surgery will typically take 6 to 12 months
The talus is one of the three bones that form the ankle joint, along with the tibia and the fibula. Injuries to the cartilage and bone of the talus are likely more common than many people know, and these injuries are often the cause of ankle joint pain that persists long after a prior ankle sprain.
If the injury to the talus is significant it may require surgery. Surgery can range from minimally invasive arthroscopic surgery possibly with a technique called “microfracture” or more invasive resurfacing of the cartilage and underlying bone. Regardless of which type of surgery is done, one of the unfortunate aspects of cartilage surgery is that recovery takes a long time. It’s common to take 6 to 12 months to return to sports.
Warning Sign: Persistent Ankle Pain Months After Prior Sprain
Ligaments are strong soft tissue structures that join a bone to a bone and give stability to a joint. Cartilage is the smooth gliding surface on the top of each bone inside a joint. Ligament injuries generally happen by stretching the ligament, and cartilage injuries frequently happen by compressing or rotating against the cartilage.
The most common area for an ankle sprain is on the outside of the joint (the “lateral” side). A warning sign for a possible talus cartilage injury is pain on the deep insideof the ankle several months after a sprain to the outsideligament. When you stretch one side of the ankle you can compress the other side, causing a cartilage injury.
If you’re having pain deep on the opposite side from a prior ankle sprain, I’d recommend you see an orthopedic specialist for further evaluation.
Treatment: Depends On Location And Extent Of The Injury
The diagnosis of a talus cartilage injury often requires a combination of imaging types. We’ll start with x-ray, and often will use MRI as a next step. A CAT scan can be used as well.
The decision process for treatment options depends on many factors. First of all, how much pain and/or limited function are you having? If several months have gone by, the problem is unlikely to heal by itself, and if you’re unhappy and limited you’ll likely need some type of surgery.
There are many factors to consider when recommending treatment that depend on the imaging. If the injured area has a small (1cm diameter or less) cartilage injury, then a minimally invasive approach can work. With arthroscopy of the ankle joint, the cartilage area is cleaned-up and tiny holes are often made in the exposed bone to stimulate formation of a scar tissue cartilage substitute. This is called “microfracture”.
For larger injured areas the treatment is controversial. There are various cartilage resurfacing options such as using a cadaver cartilage transplant, or cell-based resurfacing. These operations are most often done through larger incisions and can be combined with ligament repair. If you have a larger area of cartilage injury I would recommend you consult a foot and ankle orthopedic surgeon specialist.
Cartilage Surgery Is Slow To Heal: 6 To 12 Months Return To Sports
The specific protocol and timeline used in recovery will depend on your individual situation and will be discussed with your surgeon. In general you should expect to be on crutches at least 6 weeks after surgery, followed by a prolonged period of physical therapy and healing.
With these types of surgery it’s common to take 6 to 12 months to return to sports.