Osteochondritis dissecans of the talus

This is one of the osteochondritides, as is Freiberg's (Fig. 22.25) and Kohler's disease (Fig. 22.26). The exact aetiology is unknown but may be related to trauma. It usually occurs in younger age groups and may present as pain and swelling around the ankle joint, with or without episodes of mechanical locking secondary to loose body formation, depending on the stage of the disease. Early in the disease process a small fragment of the dome of the talus, usually in the antero-medial corner, separates from the body of the talus and may eventually form a loose body within the ankle joint. The radi-ographical appearance can vary from a small fragment of bone separate but still attached to the dome of the talus, to a defect in the dome of the talus, with or without an obvious radio-opaque loose body visible within the joint.

Treatment depends on the stage of the disease. If the fragment is still attached, internal fixation may be attempted in the hope that it will heal. However, if the bony fragment is loose, then its surgical removal from the joint is required.

Figure 22.25. Frieberg's disease of second metatarsal head (right).

Figure 22.26. Kohler's disease of the tarsal navicular (right).

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