Malleolus Research Articles

Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait.

To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. This cross-sectional study involved 22 adults between 18 and 70years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.

Ideal entry point and direction of retrograde intramedullary nailing of the tibia

PurposeTo determine the ideal entry point and direction of retrograde intramedullary nailing of the tibia.MethodsThe imaging data of patients with distal tibial fractures from June 2020 to December 2021 in our hospital were collected, and computer-aided design was performed. The relevant data were imported into the software for processing, so as to obtain a distal tibial fracture model and simulate the retrograde intramedullary nail placement in the tibia. The entry points and angles at which the intramedullary nail could be inserted successfully and the fracture could be maintained in good alignment were overlapped and counted to obtain the safe entry range and angle. The center of this safe range is the ideal entry point for retrograde intramedullary nailing of the tibia, and the mean value of the angle is the ideal direction of entry.ResultsThe ideal entry point of the retrograde intramedullary nailing was located at the midpoint of the medial malleolus in the C-arm fluoroscopic anteroposterior (AP) and lateral view. The ideal nail entry direction was located at the anatomic axis of the medial malleolus in the AP position and at the anatomic axis of the distal tibial metaphysis in the lateral position.ConclusionThe ideal point and direction of nail insertion for retrograde tibial intramedullary nailing is a "double midpoint, double axis" approach.

Tibial Retro-Malleolar Groove Morphology in Patients With Posterior Tibialis Tendon Dysfunction

The posterior tibial tendon is a gliding tendon which courses around the medial malleolus and fails in posterior tibialis tendon dysfunction (PTTD) leading to a flat foot deformity. Distal tibial bone spurs have been identified as a secondary sign of PTTD although they have not been quantified in detail. The aim of this study was to assess the association of tendon dysfunction with the bony morphology of the tibial retro-malleolar groove. We performed a retrospective review of the clinical presentation, plain radiographs, and 103 magnetic resonance imaging (MRI) scans in 82 consecutive patients with PTTD compared with a non-PTTD group. We carried out a quantitative and qualitative assessment of the presence of plain radiographic bone spurs, stage of PTTD and MRI imaging of the morphology of the tibial bony malleolar groove. Plain radiographic bone spurs, as a secondary sign of PTTD, were present in 21.3% of ankle radiographs. MRI bone spurs were identified in 26/41 (63.4%) for all high-grade partial and complete tears and 7/41 (17.1%) for isolated complete tears compared with only 3.9% of the non-PTTD group. There was a significant association between the presence of bone spurs on MRI imaging and high-grade partial and complete tibialis posterior tears (p < .001; odds ratio of 4.98). Eleven of 103 (10.7%) of spurs were large and in 4/103 (3.9%) were substantial enough to create a tunnel-like hypertrophic groove not previously reported. There is variation in the bony structure of the malleolar groove in PTTD not observed in the non-PTTD group. Further investigation over time may elucidate whether the groove morphology may lead to mechanical attrition of the tibialis posterior tendon and contribute to failure of healing and progressive tendon degeneration.

BILATERAL INSUFFICIENCY FRACTURES OF MEDIAL MALLEOLI IN AN ELDERLY PATIENT: A CASE REPORT

Insufficiency fractures (IFs) are a type of stress fractures that most commonly occur in the pelvis, followed by the proximal femur and vertebra. Less commonly, the lower leg and foot are involved. However, reports of IF of the medial malleolus are relatively rare. We herein report and discuss a case of bilateral IFs of medial malleoli in an elderly patient who was successfully treated conservatively. To the best of our knowledge, this is the first described case of bilaterally involved insufficiency fractures of medial malleoli.

High-risk stress fractures in competitive athletes

Bone stress injuries are chronic overload reactions of the bone, which are characterized by the load-dependent occurrence of locally perceived pain and tenderness on palpation at the site of the injury. Structurally normal bone becomes fatigued as a result of repetitive submaximal loading and/or inadequate regeneration. Certain stress fractures of the femoral neck (tension side), patella, anterior tibial cortex, medial malleolus, talus, tarsal navicular bone, proximal fifth metatarsal, and sesamoid bones of the great toe tend to develop complications (complete fractures, delayed union, pseudarthrosis, dislocation, arthrosis). These injuries are classified as high-risk stress fractures. Aggressive diagnostics and treatment are recommended when ahigh-risk stress fracture is suspected. Treatment is frequently different from low-risk stress fractures, including prolonged non-weight-bearing immobilization. In rare cases, surgery is indicated when conservative treatment fails, when acomplete or non-healing fracture develops, or in cases of dislocation. The outcomes of both conservative and operative treatment are described as less successful compared with low-risk stress injuries.

Physeal Bar Formation After Pediatric Medial Malleolus Fractures.

Pediatric medial malleolus fractures are commonly Salter-Harris (SH) type III or IV fractures of the distal tibia and are associated with a risk of physeal bar formation and subsequent growth disturbance. The purpose of this study was to determine the incidence of physeal bar formation following pediatric medial malleolus fracture and evaluate for patient and fracture characteristics predictive of physeal bar formation. Seventy-eight consecutive pediatric patients during a 6-year period who had either an isolated medial malleolar or a bimalleolar ankle fracture were retrospectively reviewed. Forty-one of 78 patients had greater than 3 months of radiographic follow-up and comprised the study population. Medical records were reviewed for demographic information, mechanism of injury, treatment, and need for further surgery. Radiographs were reviewed to assess for initial fracture displacement, adequacy of fracture reduction, SH type, percentage of the physeal disruption from the fracture, and physeal bar formation. Twenty-two of 41 patients (53.7%) developed a physeal bar. The mean time to diagnosis of physeal bar was 4.9 months (range, 1.6-11.8 months). Twenty-seven percent (6 of 22) of bars were diagnosed at greater than 6 months from injury. Adequacy of reduction was predictive of physeal bar formation, although all patients were reduced to within 2 mm. The mean residual displacement of patients with a bar was 1.2 mm compared with 0.8 mm for those without a bar (P=.03). Because the bar formation rate is greater than 50% on radiographs, routine radiographic assessment of all pediatric medial malleolar fractures should continue for at least 12 months after injury. [Orthopedics. 2024;47(1):e33-e37.].

The Accuracy of a Portable Accelerometer-Based Navigation System for Tibial Alignment Can be Reliable during Total Knee Arthroplasty for Obese Patients.

A portable accelerometer-based navigation system can be useful for achieving the target alignment. Tibial registration is based on the medial and lateral malleoli; however, the identification of landmarks may be difficult in obese (body mass index [BMI] >30 kg/m2) patients whose bones are not easily palpable from the body surface. This study compared tibial component alignment achieved using a portable accelerometer-based navigation system (Knee Align 2 [KA2]) in obese and control groups and aimed to validate the accuracy of bone cutting in obese patients. A total of 210 knees that underwent primary total knee arthroplasty using the KA2 system were included. After 1:3 propensity score matching, there were 32 and 96 knees in the BMI >30 group (group O) and BMI ≤30 group (group C), respectively. The absolute deviations of the tibial implant from the intended alignment were evaluated in the coronal plane (hip-knee-ankle [HKA] angle and medial proximal tibial angle) and sagittal plane (posterior tibial slope [PTS]). The inlier rate of each cohort, which was defined as tibial component alignment within 2 degrees of the intended alignment, was investigated. In the coronal plane, the absolute deviations of the HKA and MPTA from the intended alignment were 2.2 ± 1.8 degrees and 1.8 ± 1.5 degrees in group C and 1.7 ± 1.5 degrees and 1.7 ± 1.0 degrees in group O (p = 1.26, and p = 0.532). In the sagittal plane, the absolute deviations of the tibial implant were 1.6 ± 1.2 degrees in group C and 1.5 ± 1.1 degrees in group O (p = 0.570). The inlier rate was not significantly different between group C and group O (HKA: 64.6 vs. 71.9%, p = 0.521; MPTA: 67.7 vs. 78.1%, p = 0.372; PTS: 82.2 vs. 77.8%, p = 0.667). The accuracy of tibial bone cutting for the obese group was comparable to that of the control group. An accelerometer-based portable navigation system can be useful when attempting to achieve the target tibial alignment in obese patients. LEVEL OF EVIDENCE: Level IV.

Acute Effects of Selective Strength Exercise on the Peroneus Longus and Brevis

The peroneus muscles are muscles that mainly act in ankle eversion and can be divided into PL and PB, which have different but important roles in foot and ankle functions. Therefore, PL and PB dysfunction can lead to foot and ankle issues, making. selective strength exercise necessary. This study aimed to identify the effect of two different exercise techniques on PL and PB morphologies. Two interventions were performed on separate days: the PL intervention, in which a Thera-Band® was placed on the ball of the foot and pushed out from the contact point, and the PB intervention, in which the Thera-Band® was pulled from the base of the fifth metatarsal. Cross-sectional area (CSA) and thickness of the peroneus muscles at 25% (showing the PL morphology) and 75% (showing the PB morphology) proximal to the line connecting the fibular head and lateral malleolus, as well as ankle strength was measured before and immediately after the interventions and at 10, 20, and 30 min later. A repeated-measures two-way analysis of variance was conducted to identify differences in the effects of the interventions on the PL and PB. Main and interaction effects on CSA, thickness, and ankle strength, with a significant increase in CSA and thickness in the proximal 25% in the PL intervention and the distal 75% in the PB intervention immediately after implementation, were observed (p &lt; 0.05). The transient increase in muscle volume due to edema immediately after exercise indicates the acute effect of exercise. The CSA and thickness of the proximal 25% in the PL intervention and the distal 75% in the PB intervention increased immediately after the intervention, indicating that these interventions can be used to selectively exercise the PL and PB.

Tricortical bone graft from lateral malleolus as an alternative for iliac crest graft in the operative treatment of foot deformities: graft harvesting technique and its application

The paper describes the technique and application of a tricortical bone graft harvesting from the lateral malleolus. Graft harvesting does not interfere with the continuity of the fibula. Due to its structure, the graft is equivalent to a similarly structured graft taken from the iliac crest. The graft is used in osteotomies and arthrodesis within the foot and ankle joint, which require a strong piece of bone as a wedge. The author typically uses this type of graft for osteotomy of the anterior part of the calcaneus with an opening wedge (Evans’ osteotomy), calcaneal-cuboid arthrodesis, talo-calcaneal arthrodesis, especially after calcaneal fractures, Green-Grice extra-articular talo-calcaneal arthrodesis and Dwyer II of calcaneus osteotomy for the correction of varus deformity with opening wedge from the middle, opening wedge osteotomy of medial cuneiform and supplement bone defects in techniques requiring lengthening of metatarsals.

Classics. Fibular hemimelia or deficiency (defectus fibulae)

The author presents an original technique of reconstruction of the ankle joint (including reconstruction of the lateral malleolus) in the congenital absence of the fibula.

Efficacy of Irsal-i-Alaq (Hirudotheraphy) in the Management of Venous Ulcer: A Case Report

Background: The most frequent and recurring type of leg ulcers seen in general practise is a venous ulcer (stasis ulcer). Its neglect has a considerable negative influence on quality of life, might result in gangrene, and may necessitate amputating the affected limb. The most serious and incapacitating complication of chronic venous insufficiency is venous ulcer. The conventional system of medicine offers limited clinical evidence for its effectiveness and usually needs amputation. Hence, it can be managed well by one of the Unani regimens, i.e., Irsal-e-Alaq (Hirudotherapy). Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) in venous ulcer. Intervention: A 53-year-old male who has complaints of ulcer in left lower leg near lateral malleolus with swelling, pain, discharge and darkening of skin of left lower limb. Four leeches were applied once every 15 days for 45 days. Ulcer was assessed on 0th day, 15th day, 30th day and 45th day on the basis of area of the wound in a square centimetre, appearance of healthy granulation tissues, epithelization in percentage and depth of wound in centimetres, pain (VAS scoring), discharge, smell and number of wounds. Results: on the first day wound size was 4 cm long, 3 cm wide, 2 cm deep and the floor filled with dark granulation tissue with 0 % epithelization, discharge, pain and smell. On the 45th day ulcer was completely healed with 100% epithelization. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patients' quality of life. To determine the effectiveness of Irsal-e-Alaq in the management of venous ulcer, rigorous, controlled, randomised, blinded, and long-term follow-up studies on high sample sizes are required.&#x0D; Keywords: Hirudotherapy, Unani Medicine, Leech Therapy, Varicose Ulcers

Surgical treatment of sural nerve entrapment aided by imaging- and electrography-based diagnosis: illustrative case.

The sural nerve (SN) is a cutaneous sensory nerve that innervates the posterolateral side of the distal third of the leg and lateral side of the foot. The SN has wide variation in its course and is fixed to the subcutaneous tissue and superficial fascia. Idiopathic spontaneous SN neuropathy is rarely surgically treated because of the difficulty in detecting SN entrapment. Herein, the authors present a rare case of surgically treated spontaneous SN neuropathy. A 67-year-old male patient presented with right foot pain for several years. Magnetic resonance imaging and ultrasonography showed SN entrapment slightly proximal and posterior to the lateral malleolus. A nerve conduction study showed SN disturbance. After undergoing neurolysis, the patient's foot pain was alleviated. Idiopathic SN neuropathy can be treated surgically when SN entrapment is detected with comprehensive evaluation methods.

Relationship between the Young's Modulus of the Achilles Tendon and Ankle Dorsiflexion Angle at Maximum Squat Depth in Healthy Young Males.

Background and Objective: Achilles tendon (AT) stiffness can reduce ankle dorsiflexion. However, whether AT stiffness affects the ankle dorsiflexion angle at a maximum squat depth remains unclear. Therefore, we aimed to investigate the relationship between the Young's modulus of the AT and ankle dorsiflexion angle at the maximum squat depth in healthy young males using shear-wave elastography (SWE). Materials and Methods: This cross-sectional study included 31 healthy young males. AT stiffness was measured using the Young's modulus through SWE. The ankle dorsiflexion angle at the maximum squat depth was measured as the angle between the vertical line to the floor and the line connecting the fibula head and the lateral malleolus using a goniometer. Results: Multiple regression analysis identified the Young's modulus of the AT at 10° of ankle dorsiflexion (standardized partial regression coefficient [β] = -0.461; p = 0.007) and the ankle dorsiflexion angle in the flexed knee (β = 0.340; p = 0.041) as independent variables for the ankle dorsiflexion angle at maximum squat depth. Conclusions: The Young's modulus of the AT may affect the ankle dorsiflexion angle at the maximum squat depth in healthy young males. Therefore, improving the Young's modulus of the AT may help increase the ankle dorsiflexion angle at maximum squat depth.

Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study

BackgroundThe purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula.MethodsThis retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS).ResultAmong patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate.ConclusionFor simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.

ID: 219222 Peripheral Nerve Stimulation for Refractory Plantar Fibromatosis Pain: A Case Report and Literature Review

41-year-old man was referred by orthopedics to the outpatient pain clinic with history of chronic bilateral plantar heel pain and a diagnosis of plantar fibromatosis following diagnostic ultrasound evaluation. He had failed numerous non-operative treatments including shoe wear modification, orthoses, physical therapy, acupuncture, shock wave therapy, ultrasound guided corticosteroid injection, and percutaneous needle tenotomy. Upon initial consultation, the patient endorsed a 5-year history of bilateral medial plantar heel pain, provoked with weight bearing activities. He denied paresthesias and weakness. Given his refractory symptoms joint the decision was made to proceed with a diagnostic block of his more symptomatic side with goal to pursue bilateral percutaneous 60-day peripheral nerve stimulator placement if he experienced a favorable response. Diagnostic target was the left tibial nerve just proximal to the medial malleolus and prior to its division into plantar and calcaneal branches. Diagnostic injectate consisted of 2cc 1% lidocaine and 5mg of dexamethasone for a total volume of 2.5cc. Patient rated his pain 8/10 prior to injection and 0/10 following. He subsequently underwent placement of dual peripheral nerve stimulators targeting the bilateral tibial nerves with implantation 5cm proximal to the medial malleoli. At 60 day follow up, the device was explanted. The patient was no longer tender with palpation of either foot. He reported 50% reduction compared to pre-operative pain, significant improvement in his quality of life and physical functioning, and a reduction in oral analgesic regimen. The patient is currently awaiting permanent stimulator placement.

Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study.

For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal. To clarify the visibility and safety of needle arthroscopy. Descriptive laboratory study. Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals. The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals (P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals (P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens. When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle. The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.

The Effect of Sensor Placement on Measured Distal Tibial Accelerations During Running.

Inertial measurement units (IMUs) attached to the distal tibia are a validated method of measuring lower-extremity impact accelerations, called tibial accelerations (TAs), in runners. However, no studies have investigated the effects of small errors in IMU placement, which would be expected in real-world, autonomous use of IMUs. The purpose of this study was to evaluate the effect of a small proximal shift in IMU location on mean TAs and relationships between TAs and ground reaction force loading rates. IMUs were strapped to 18 injury-free runners at a specified standard location (∼1cm proximal to medial malleolus) and 2cm proximal to the standard location. TAs and ground reaction forces were measured while participants ran at self-selected and 10% slower/faster speeds. Mean TA was lower at the standard versus proximal IMU location in the faster running condition (P = .026), but similar in the slower (P = .643) and self-selected conditions (P = .654). Mean TAs measured at the standard IMU explained more variation in ground reaction force loading rates (r2 = .79-.90; P < .001) compared with those measured at the proximal IMU (r2 = .65-.72; P < .001). These results suggest that careful attention should be given to IMU placement when measuring TAs during running.

Clinical efficacy analysis of repairing the medial malleolus canal combined with double incision on the plantar surface for ankle-related ganglion cysts.

Clinical efficacy analysis of repairing the medial malleolus canal combined with double incision on the plantar surface for ankle-related ganglion cysts.

Surgical treatment of ankle instability in children with os subfibulare.

Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability require surgical treatment. A rarer cause of developing ankle instability is injury to the ligament complex in the presence of os subfibulare, an accessory bone inferior to the lateral malleolus. The aim of this study was to assess the results of operative management of chronic ankle instability in children with os subfibulare. 16 children with os subfibulare and chronic ankle instability who failed non-operative treatment were enrolled prospectively into the study. One child was lost to follow-up and excluded from analysis. The mean age at the time of the surgery was 14years and 2months (range 9.5-17years). The mean follow-up time was 43.2months (range 28-48months). Surgical treatment in all cases involved removal of os subfibulare and a modified Broström-Gould lateral complex reconstruction with anchors. Ankle status was assessed before and after surgery with The 100mm Visual Analogue Scale and Foot and Ankle Outcome Score questionnaire. The mean Foot and Ankle Outcome Score improved from 66.8 to 92.3 (p < 0.001). Pain level improved from 67.1 preoperatively to 12.7 (p < 0.001). All children reported improvement in their ankle stability. There was one case of scar hypersensitivity that improved during observation and one superficial wound infection that resolved with oral antibiotics. One child reported intermittent pain without symptoms of instability following another injury. Ankle joint sprain with associated injury to os subfibulare complex can lead to chronic instability in children. If conservative management fails, then surgical treatment with modified Broström-Gould technique and excision of accessory bone is a safe and reliable method.

Osteochondral lesion of the talus: presentation and management - A case report

Osteochondral lesions of the talus (OLT) involve the chondral and subchondral region typically. Most are secondary to trauma. The patients present with pain, stiffness, swelling. Diagnosis is made typically by clinical and radiological correlation. Treatment strategies employed can be conservative or surgical. This case report is of a 24-year-old male, who presented with pain on the right ankle ,for a chronic period following trauma. The patient was diagnosed with OLT and underwent surgical treatment (Right medial malleolus osteotomy +curettage of right talus + bone grafting + reconstruction of the medial malleolus). This case study is aimed at understanding the various treatment strategies for OLT, both surgical and non-surgical and thus arriving at a conclusion. Treatment of osteochondral lesions is mainly by early screening in high-risk patients (trauma). Although outcomes are favorable in most of the cases, treatment should be individualized to every patient with adequate counseling of outcomes and complications.