OCD (osteochondritis dessicans) Lesions

[bvpv07]

Does anyone have any experience or information about them?

I guess that they finally figured out what's wrong with my feet...

My last MRIs showed multiple OCD lesions on the tallus and navicular of both feet (although the ones in the right foot are worse). Four and a half months in aircast boots and over six months of strict physical inactivity wasn't enough to heal them...and they've been around for two years.

Right now my ortho's plan is to get another set of MRIs (to see if anything's changed), and, if they're still there (the pain's still there, so they probably are), perform surgery.

I was told today that my senior season won't happen. APPRECIATE HEALTH! The only season that I was able to compete and vault was my freshman year

[rainbowgirl28]

What are the odds of the surgery helping? If it can fix it in the long term than that's a good thing. Do they think you have these on your back too?

[bvpv07]

The back's doing fine. I've found that it gets tight or sore after a shorter period of time than it did before, but the pain's gone. They still don't know what caused that, but we (my pts and me) think that the disks were probably compressed from drills that I did when I couldn't do anything on my feet.

He didn't really detail the surgery since the MRIs are the first step along that route...but apparently that's the way that you treat them. I did an internet search and only got articles on OCD lesions in the knee and in animals (mostly horses and dogs); that's why I'm interested in any info that anyone here could share.

[rainbowgirl28]

I'll try to ask my dad about it tomorrow.

[bvpv07]

Thanks, Becca!

[Spencer Chang, MD]

I guess the real question is how much pain are you having and is it hampering your ability to pole vault? In all likelihood this is really an osteochondral lesion of the talus, which usually occurs from ankle sprains.

My analogy is that it is like having a pothole in the cartilage of your ankle bone. I suspect the cartilage lesion on your navicular may be a reaction to the lesion on your talus.

I would have to look at your MRI and examine you to figure it out.

Are you going to the Summit? Maybe I can look at it there.

Typically, I don't treat these in immobilization that long. Although limiting impact loading (jumping and running) may allow new "fibrocartilage", which is weaker that normal cartilage, but healthier than no cartilage, fill in... sometimes this doesn't work. Also, there have been studies that suggest immobilization isn't good for cartilage. In the ankle, there is a give and take. When we immobilize our patients, they put less stress and pressure on their joints. However, if one were to keep weight off of the limb but move the joint gently, it is probably better for the cartilage to heal. How many people would truly stay on crutches if it doesn't hurt to walk? That's why doctors place their patients in cam walking boots or casts. But half a year... come on.

If the lesion is truly causing pain, then it is really the beginnings of arthritis in that joint. However, if the lesion is small, there are procedures which may allow fibrocartilage to grow back in the defect and make it at least asymptomatic and feel normal.

If the pain is more from inflammation in the joint and soft tissue impingment or synovitis, anti-inflammatories or cortizone shots may help. However, cortizone can actually weaken or possibly damage the cartilage if taken in excess, so be careful.

Glucosamine and Chondroitin Sulfate is like taking vitamins for your cartilage. It might not help, but it is unlikely to hurt you except for your wallet.

If you can, bring your MRI, bone scans, and x-rays and I'll be happy to look at them in 2 weeks.

Good Luck,

Orthopaedic Surgeon, Dual Fellowship Trained in Sports Medicine, and Foot and Ankle Surgery.

Medical Advisor to USATF Pole Vault Development

University of Hawaii Pole Vault Coach

[bvpv07]

Wow, thank you Dr. Chang!

I'll try to get my x-rays, bone scans, and MRIs, but my ortho just changed offices so it might be a bit difficult. If I am able to get them, I will definitely bring them up to Reno with me.

The ankle sprain reason makes a lot more sense than "being really active." I was a gymnast for twelve years before I started pole vaulting, and, during that time, sprained my ankles (particularly my right) so many times that now they are prone to giving out and flattening without pain.

I probably should have added that the six months also involved dealing with a back injury that severly limited what I was capable of doing. That started just before I was in my second boot on the left foot, and it got to the point where I couldn't do anything. They figured that it was better for me to just do nothing at all from May to November so that the back (which remains undiagnosed, but healed with enough down time) and feet could heal.

The pain is only there when I vault, run, sprint, or jump. If I haven't done any of those things, I have minimal pain when the area is pressed against and none when I'm walking. This has led doctors to believe that it's healed itself and give me the ok to start working out again. However, once I do start running and vaulting, it comes back (almost immediately). If I continue to try to vault, the pain has caused me to limp and it hurts to walk or even stand. I don't know if that would still happen, because my coach has been really careful about not pushing it since I came back from the back injury and the time off. I do know that, when it hurts at practice, it will continue to hurt for the rest of the night when I'm walking.

Anti-inflammatories haven't resulted in any pain reduction; right now I come home and ice whenever they hurt.