Osteochondral lesions (OCLs) of the talus are not uncommon, the diagnosis of which requires a high index of suspicion and is often delayed. The purpose of this presentation is to raise awareness and discuss treatment outcomes of OCLs.

All patient notes with a diagnosis of talar OCL over a 12-month period were retrospectively analysed. A telephone questionnaire was then performed in which patients were asked to compare current symptoms to pre-operative symptoms using a numerical scoring system.

There were thirteen patients with a mean age of 31. A history of trauma was present in eleven (85%) and all had activity related pain. OCLs were evident on plain radiographs in six (46%). The diagnosis was made in the remainder on MRI or at arthroscopy. Median time between initial orthopaedic assessment and diagnosis was 4 months (0–100). The OCLs were medial in six (46%) and lateral in seven (54%). Eleven patients were treated with excision and penetration of subchondral bone, 1 underwent open fixation and 1 had an isolated chondral lesion treated conservatively. Mean follow-up was 6 months (2–14). Seven (54%) had minimal or no symptoms and three (23%) only after prolonged activity. Ten (77%) were better than before surgery, one (8%) the same and two (15%) were worse. The three patients who were the same or worse had had a delay in diagnosis of over 12 months.

Patients with talar OCL often have persistent ankle pain which remains undiagnosed. Early diagnosis and treatment offers the best chance for a good outcome.