Ankle injury diagnosis

Osteochondral lesion of the talus

I’ve been injured for a long time. For months. Actually, for the better part of a year. With no signs of improvement or relief. No timetable for a return to running. I’m inclined to share the entire months-long progression, but that’s not really useful to anyone. After exhausting all other options, I finally did what I should’ve done weeks ago and got an MRI.

Osteochondral lesion of the talus. There is a fracture in the cartilage that sits at the top of the talus bone in my left ankle, and the underlying bone has been damaged considerably. I remembered thinking once, “ok, it’s gotta be either a stress fracture or arthritis.” I wasn’t far off. And I was closer than most professionals had come.

An OLT is a tricky injury, I’ve now learned. Cartilage isn’t known for its ability to repair itself or regrow, and the talus is a very low-blood-flow area. A scope surgery is one of the only ways to treat this injury successfully. This procedure allows for cleaning debris from the injured area and drilling into the talus to create a microfracture. Ideally, this chain of events encourages new bone to grow and scar tissue will fill in for the cartilage.

That is the surgery I am now scheduled to have next month. That is the part I want to share. I spent months Googling my symptoms, trying to find a home for my injury, only to find very little reliable information and misdiagnose myself repeatedly.

I’m a runner. I’ve had all the “traditional” soft tissue injuries and a metatarsal fracture, too. But this is a new one for me, and the most difficult one for sure, especially when it’s been years since my last major injury. For weeks I wished it was a stress fracture – so straightforward! Almost guaranteed to run again in 8-12 weeks. Currently, I’m so far away from my usual place of fitness that going into surgery at this point is like “well, what’s another 6 weeks.” But at least I have a time frame, finally.

In the meantime, I’ll be updating throughout my pre-op phase, and then detailing the surgery and recovery plan. I struggled to find the information I needed, so I hope I may be a resource for someone else.

Predominate symptoms I experienced over the last 8 months:

  • A crunching, grinding, catching sensation inside the ankle joint
  • Shooting pain or a compressive ache in the ankle while ascending stairs or pedaling a bike
  • Midfoot instability
  • Sharp pain at the front of the ankle that was confused with both a cuboid fracture and impingement syndrome
  • Skin numbness across the bridge of the ankle, where you tie your laces, and behind the ankle on the lateral side
  • Joint pain in the medial arch of my foot
  • Swelling near the peroneal tendons
  • Pain and pinching behind the ankle on the medial side

Because of these symptoms, various physical therapists and doctors diagnosed me with a wide range of afflictions from plantar fasciitis to cuboid subluxation to tarsal tunnel syndrome – and keep in mind, none of these even occur in the same part of the ankle. That’s how much the pain migrated. I was able to run with it for about four months, and finally started to feel like the whole ankle was about to shatter, at which point I stopped.

Conservative treatments I tried:

  • Rest. Like, days, then weeks, then months of rest
  • Cross-training on the elliptical or bike
  • Dry needling, laser therapy, manual therapy, ice massage, NSAIDS
  • Air cast walking boot
  • Running? We all think maybe it’ll just “clear up”

Osteochondral lesion of the talus. I went to 4 physical therapists over this time. That’s maybe the most frustrating part. Every misdiagnosis made me feel like I wasn’t being heard. Like everyone was confirming their own biases instead of listening when I repeatedly said SOMETHING HURTS INSIDE THE ANKLE. It’s not the fucking plantar fascia! I often wish I had gotten imaging earlier. Thinking how much time I wasted beating myself up over useless rehab exercises, wondering what I was doing wrong… Knowing somewhere in my heart that it would lead to this. That it had to.

But I can’t dwell on that. That chapter is behind me. When I left the consultation with my physical therapist after he’d received my MRI results, I said, “You know, I actually feel excited. Relieved. A little scared. The hard part is over, and I see a light at the end of the tunnel.”

* * *

If you have experience with this or another similarly drawn-out injury, please reach out! Constructive, supportive feedback is something you can’t find over at the LRC message boards.