Use of Functional Foot Measurement in a Young Male with Osteochondral Defect of Talus

Randie Kuhar, Master of Athletic Training Student

Mentors: Dr. Kelly Stalker, Dr. Michele Monaco, Dan Holman, & Kate Daniels

Background International Classification of Function (ICF)

Osteochondral lesion of talus (OLT): Health Condition
An area of abnormal, damaged cartilage, and bone on the Osteochondral defect of talus
superior portion of the talus. It is often associated with
traumatic injury, such as a severe ankle sprain. However, it
can also occur from chronic overload due to malalignment
or instability of the ankle such as ankle fractures and Body Function & Structure Activity Participation
weakness on the lateral ankle. Impairments in ROM & strength,
Difficulty walking and running on Participates in sporting activities
decrease in overall well-being uneven surfaces, ambulation of stairs, as tolerated
Cutting/lateral Movements
OLT commonly occurs in two areas of the talus:
- Medial talar dome
- Antero-lateral talar dome
Personal Factors Environmental Factors
Treatment Options: Initial injury did not properly PT & AT are advocates, external
Non-Surgical: rest, cast immobilization, NSAIDs, heal, Contact Sport, High School stressors from parents/coaches
physical therapy, protective braces Senior

Figure 1: Radiograph with arrow

Surgical: Arthroscopic debridement and microfracture of
pointing to a typical osteochondral Interventions Conclusion
the talar OLT, mosaicplasty, and bone and cartilage plug
lesion of the talar dome in a similar
(i.e., cadaver) The patient chose to play through his final football
location to the patient’s lesion
season knowing the risk of his injury.

Case Description Examination FAAM scores decreased over a two-week span,

indicating a decreased level of function, despite
• 17-year-old male patient  Foot and Ankle Ability First Visit Second Visit Third Visit strength improvements. Patient reported scores
Measure (FAAM) 10/13/2021 10/20/2021 10/27/2021 most likely decreased due to limited ROM.
• High School Senior
• Varsity Football and Wrestling Daily Living –   • Plantarflexion decreased by 2° and had 7° less
Patient Score 72/84 = 86% 60/84 = 71% 55/84 = 65%
ADL Score 70% 60% 60%
ROM than un-involved ankle.
Injury Presentation Sport Subscale – • Dorsiflexion increased by 2° but was still 5° less
• Initial Injury on 2/13/2021 (wrestling season) Patient Score 19/32 = 59% 17/32 = 53% 17/32 = 53% than the un-involved ankle.
ADL Score 60% 60% 50%
• No date for “re-injury”. Athlete went back to the doctor
Overall Level of Function Nearly Normal Abnormal Abnormal When bilaterally comparing the circumferential
in fall 2021 due to consistent pain (start of football)
• Foreign body was found in the ankle and patient was Left Ankle Right Ankle
measurements, significant differences were seen
given two options: Un-Involved Involved • Exercises: Biking, Towel Stretch, between the malleoli girth and moderate
1. Continue to play through football season with Initial Last Initial Last Gastroc/soleus, DF/PF Thera-Band, Single Leg differences in mid-calf girth. The circumference
surgery to follow and patient knowing the risks Active Range of Motion Measurements Balance, Calf raises, Toe yoga, Glute Bridge w/ change over this time period was insignificant.
2. End the season and get surgery immediately Plantarflexion 35 36 31 29 resistance
Dorsiflexion 75 77 70 72 • Tape Techniques as pictured below Surgery was completed in November 2022. The
• MOI: Inversion of right ankle Circumferential Measurements athlete did not follow-up after surgery.
• Nature: Acute Malleoli Girth 48.3cm 48.5cm 30.3cm 31cm
• Body Part: R Ankle Musculotendinou 35.5cm 35.7cm 35cm 37cm
• Edema: (+) Irregular Pitting about entire lateral ankle
s Junction Girth
(Achilles’ tendon) References
• PtT: Immediate onset lateral ankle Mid-Calf Girth 48cm 49cm 46.2cm 45.8cm
Figure 2b
Figure 2a

1. Hunt, K. (2017, July 31). Osteochondral lesion of the talus (OLT).

• ROM: Limited due to pain Manual Muscle Testing FootEducation. Retrieved November 24, 2021, from
• Strength: Not tested due to pain Plantarflexion 5/5 5/5 3/5 4/5 https://footeducation.com/osteochondral-lesion-of-the-talus-olt/. 
• Neuro: (-) Paresthesia, Cap refill WNL Dorsiflexion 5/5 5/5 3/5 4/5 2. Massachusetts General Hospital. (n.d.). Osteochondral lesion of the talus
• Figure 2a/2b: Elastikon was used to pull the foot into
Special Test:(+) Tap, (+) Compression, (+) Tuning Fork Inversion 5/5 5/5 Not 3/5 (OLT). Osteochondral Lesion of the Talus (OLT). Retrieved November 20,
dorsiflexion, following this, a traditional ankle tape was 2021, from
• Differential Diagnosis: Ankle Fx Tested
done to provide more stability https://www.massgeneral.org/orthopaedics/foot-ankle/conditions-and-
Eversion 5/5 5/5 Not 4/5 treatments/ocd-osteochondral-defect.
Tested