“My recent MRI?”
I recently had an MRI where it was discovered I had an OLT on my ankle alongside a detached fragment on my talar some. What would be the next treatment for this diagnosis?
Report:
EXAMINATION: MRI OF THE RIGHT FOOT AND ANKLE, WITHOUT IV CONTRAST
CLINICAL HISTORY: Right ankle pain following injury 2012. Right
foot pain.
COMPARISON: Radiographs from 9/27/2021
PROCEDURE COMMENTS: Multiplanar multisequence MR imaging of the
right foot and ankle were obtained without intravenous contrast.
FINDINGS:
TENDONS: The Achilles tendon is intact. The extensor, flexor and
peroneal tendons are intact, without evidence for tendon tear,
tenosynovitis or tendinosis.
LIGAMENTS: Mild heterogeneity and indistinctness of the ATFL
compatible with chronic tear. The PTFL and CFL are intact.
Tibiofibular syndesmotic ligament and deltoid ligament are
intact. Lisfranc ligament is intact.
OSSEOUS STRUCTURES/JOINTS: 11 x 6 mm osteochondral lesion at the
lateral talar dome, with 6 mm detached fragment. Subtalar
articulations are intact. No evidence for osseous coalition.
Hallux valgus. Mild degenerative changes at the first MTP joint,
hallux sesamoid complex and interphalangeal joint of the great
toe, compatible with osteoarthritis. No evidence for acute
fracture or osseous erosion.
FLUID: No pathologic joint effusion or focal collection.
PLANTAR FASCIA: Unremarkable.
SINUS TARSI: Unremarkable.
INTRINSIC MUSCLES OF THE FOOT: Unremarkable.
ADDITIONAL FINDINGS: None.
Impression:
1. Osteochondral lesion at the lateral talar dome with 6 mm
detached fragment.
2. Chronic ATFL tear.
3. Hallux valgus. Mild degenerative changes.
4. Other findings as described.
Report:
EXAMINATION: MRI OF THE RIGHT FOOT AND ANKLE, WITHOUT IV CONTRAST
CLINICAL HISTORY: Right ankle pain following injury 2012. Right
foot pain.
COMPARISON: Radiographs from 9/27/2021
PROCEDURE COMMENTS: Multiplanar multisequence MR imaging of the
right foot and ankle were obtained without intravenous contrast.
FINDINGS:
TENDONS: The Achilles tendon is intact. The extensor, flexor and
peroneal tendons are intact, without evidence for tendon tear,
tenosynovitis or tendinosis.
LIGAMENTS: Mild heterogeneity and indistinctness of the ATFL
compatible with chronic tear. The PTFL and CFL are intact.
Tibiofibular syndesmotic ligament and deltoid ligament are
intact. Lisfranc ligament is intact.
OSSEOUS STRUCTURES/JOINTS: 11 x 6 mm osteochondral lesion at the
lateral talar dome, with 6 mm detached fragment. Subtalar
articulations are intact. No evidence for osseous coalition.
Hallux valgus. Mild degenerative changes at the first MTP joint,
hallux sesamoid complex and interphalangeal joint of the great
toe, compatible with osteoarthritis. No evidence for acute
fracture or osseous erosion.
FLUID: No pathologic joint effusion or focal collection.
PLANTAR FASCIA: Unremarkable.
SINUS TARSI: Unremarkable.
INTRINSIC MUSCLES OF THE FOOT: Unremarkable.
ADDITIONAL FINDINGS: None.
Impression:
1. Osteochondral lesion at the lateral talar dome with 6 mm
detached fragment.
2. Chronic ATFL tear.
3. Hallux valgus. Mild degenerative changes.
4. Other findings as described.
Male
Complaint duration: 9years
7 Answers
my conclusion of your post, without exam of course. you have a old injury to your ankle with a torn ligament, remience of a old floating fragment of bone inside the ankle joint. along with a bunion ( hallux valugus) with mild arthritis. I recommend for you to go back to see your doctor that ordered the mri, or find a foot and ankle specialist around you for consultation. hope you get back the quality of life you want.
Surgery to remove fragment and debride cartilage.....
I recommend you follow up with the practitioner who ordered the MRI and discuss options
An OCD (osteochondral defect) of the Talus/Talar Dome is a lesion from gouging the cartilage on the talus, which is part of your ankle joint. If this requires surgery, it is an OATS procedure you should have to fill the void in the cartilage defect. At the same time, it seems you have a Anterior Talo-fibular ligament tear (chronic). It may need to be repaired. See a 3-year surgically trained board certified Podiatrist in your area for treatment options.
Surgery. This condition does not respond to conservative treatment.
An Orthopaedic evaluation is needed with new films/xrays and possible advanced imaging
The loose fragment should be removed. This can often be done with minimally invasive surgery.
Christopher B. Michelsen, MD, FAOA, FAAOS, FACS
Christopher B. Michelsen, MD, FAOA, FAAOS, FACS
