The ankle joint is a very common site for injury during sports and many of our daily activities. Most twisting and inversion injuries of the ankle joint result in ligament damage.  This presents with a combination of pain and instability that usually requires short periods of immobilisation followed by physiotherapy.

The management of ankle joint ligament injuries is covered here.

Despite proper conservative treatment and physiotherapy input, some patients continue to experience ankle pain following an injury.  The pain here is slightly different from that caused by ligament damage.  The pain is usually in the form of a deep, dull ache with little if any sense of giving way and instability.  This could be a sign of a cartilage lesion within the ankle joint.

Like all our joints the ankle is covered by nice glistening cartilage.  This cartilage allows the movement to happen in a seamless way.  This cartilage is supported by strong subchondral bone that helps the joint to withstand the weight and the stresses applied on it.

The injury usually causes a crack in the cartilage which allows the fluid from within the joint to escape to the subchondral bone. This causes an area of increased pressure within the bone which in turn affects the circulation of this segment, causing it to die.  This creates a weak spot within the joint and causes this deep dull ache that the patient experiences on any physical activity.

The treatment of these cartilage lesions demands a thorough clinical examination and investigation with x-rays and other modalities like an MRI or a CT scan.

The management depends on the symptoms the patient is experiencing as well as the size and the location of these lesions.  Other factors that affect the decision making include the age of the patient and his general health including smoking, as well as the condition of his ankle joint and whether the remaining part of the joint is still healthy or has started a process of arthritis.

For management of small and large cartilage lesions within the ankle joint click here.