Nonsurgical Treatment
Treatment for OCD depends on when the problem is discovered. If the problem is discovered immediately after a twisting injury to the ankle, immobilization in a cast for six weeks may be suggested to see if the bone injury heals. You may need to keep weight off the foot and use crutches during this period of immobilization.
Surgery
If the problem is not recognized early, the bone fragment may not heal and may continue to cause problems. Surgery may be required to try to reduce your symptoms at this point.
Surgery usually involves removing the loose fragment of cartilage and bone from the ankle joint and drilling small holes in the injured bone. When the fragment is removed, a defect shaped like a small crater is left in the talar dome. It is this area where the drill holes are made. The drill holes allow new blood vessels to grow into the defect and help to form scar tissue to fill the area. Eventually this new scar tissue smoothes out the defect and allows the ankle to move more easily.
Arthroscopic Method
In some cases the surgery may be done using an arthroscope. An arthroscope is a special miniature TV camera that is inserted into the joint through a very small incision. Special instruments are inserted into the ankle through other small incisions. By watching on the TV screen, the surgeon removes the fragment and drills the defect.
Open Method
The ankle is a small joint, so it is sometimes difficult to get the arthroscope into certain areas. If the defect is in an area of the ankle difficult to reach with the arthroscope, an open incision may be required. This incision is usually made in the front of the ankle to allow the surgeon to see into the joint. Special instruments are used to remove the fragment and drill the injured area.
Rehabilitation
What should I expect following treatment?
Nonsurgical Rehabilitation
If your surgeon recommends nonsurgical care with a cast or boot, you will probably use crutches for at least six weeks. During follow-up office visits, X-rays are taken so that the surgeon can follow the healing of the fragment and determine whether surgery will be necessary.
After Surgery
Patients normally require crutches to keep from putting weight on the ankle for four to six weeks. Surgeons may have their patients start doing motion exercises very soon after surgery. Patients wear a splint that can easily be removed to do the exercises throughout the day.
You will probably wear a bandage or dressing for a week following the procedure. The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won't need to have the stitches taken out.
Your surgeon may have you take part in formal physical therapy after surgery. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. Physical therapists will also work with you to make sure you are only putting a safe amount of weight on the affected leg.
The physical therapist will choose exercises to help improve ankle motion and to get the muscles toned and active again. At first, emphasis is placed on exercising the ankle in positions and movements that don't strain the healing part of the cartilage. As the program evolves, more challenging exercises are chosen to safely advance the ankles' strength and function.
Some of the exercises you'll do are designed to get your leg and ankle working in ways that are similar to the activities you do every day, such as rising on your toes, walking, and going up and down stairs.
The physical therapist's goal is to help you keep your pain under control, ensure safe weight bearing, and improve your strength and range of motion. When you are well underway, regular visits to the therapist's office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
