Talar dome lesion – a complication of ankle sprain

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Talar dome lesion refers to an injury to the surface of the bone in the ankle joint, the Talus. It’s a sneaky injury that can be a complication of a “typical” ankle sprain because it’s not always obvious in the first few weeks post-injury, even with a clinical assessment.

Talar dome lesions typically involve damage to the smooth cartilage surface overlying the bone. And given that your entire body weight rests on this small cartilage surface, it’s got to deal with some pretty big loads during your daily life.

Classic symptoms include an increased recovery time after an ankle sprain, recurrent swelling with normal activity and an ongoing deep ache during/after activity.

Increased recovery time can be a little vague but it’s basically an ankle sprain that seems to take “forever” to get better. When you rolled it, you thought it’d be 4 weeks to return to running but 8 weeks later, it’s still not recovered enough to try a run.

Recurrent swelling that tends to fluctuate from morning to evening is another concern. You wake up just fine, no obvious swelling. But by mid afternoon, there’s a cherry-sized lump forming on front of your lateral (outside) ankle bone. And it’s gone again by the next morning, only to repeat the same pattern. It’s called “intracapsular effusion” and it’s a sign that something inside the joint is producing fluid.

A deep ongoing ache is another sign, although it’s not unique to talar dome lesions. It’s a consistent dull ache that you can’t put your finger on. It hurts but there’s no spot that you push on to produce the same pain. The pain is often described as “deep inside the joint”.

Talar dome lesion treatment options

Clinical testing by a health professional is unable to detect talar dome lesions. We just can’t do anything to load that part of the cartilage in isolation to confirm the diagnosis. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint.

Imaging for talar dome lesions is best done with MRI. MRI will show both the size of the damaged area as well as the reaction in the bone below the injury. The size of this reaction will often affect rehab time frames. Although X-ray may visualise a lesion, it’s hit & miss in actually spotting it and can’t see any bony reaction. That means a clear X-ray may not mean that you’re clear of injury. Even if it sees a damaged area, we can’t tell if it’s a new or old lesion (without seeing the reaction).

To improve the early recovery after injury, look at routine supportive taping or bracing to prevent aggravating the cartilage defect. You’ll also need to keep the swelling at a minimum using ice packs and compressive bandaging. Crutches usually aren’t required unless it’s a severe case with lots of pain or swelling.

Surgical repair of talar dome lesions are only required for very large defects (typically >1 square cm) as most lesions recover well with non-surgical approaches such as controlled reloading and strength exercises.

Why does a talar dome injury take so long to recover?

While a defect in joint cartilage may sound and feel nasty, they’re surprisingly common. About 7%, or 1 in 14, ankle sprains have an associated talar dome lesion. We only tend to find the worst ones because the smaller or milder injuries often go unnoticed. They’ll improve with regular ankle sprain rehab so you’ll never know you’ve damaged your cartilage.

You may be frustrated but remember, there’s no magic to recovering from a lesion. It’s the same rehab but at a slower pace. Recovery time frames are often double or triple the duration of a typical recovery. So you’ll need to be patient, persistent and listen to advice, even when it seems like you can do more.

Prolonged use of anti-inflammatory meds is a bad idea, even with recurrent swelling over the initial weeks. A short spell of meds can be helpful. But ongoing use is likely to inhibit the bone recovery and mask the warning signs of excessive activity levels. If you feel you need to be on them after 3-4 weeks, it’s probably worth re-evaluating your current level of activity and backing off a little.

If it’s not a talar dome lesion, what else could it be?

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