Osteochondritis Dissecans (OCD) of the Talus

Epidemiology

  • Talus is second most common site for OCD
  • Commonly occurs anterolaterally or posteromedially
  • 50% children present after trauma. Mean age of presentation is 13-14 years

Classification

GradingDescription
Iundisplaced
IIpartially detached
IIIdetached but not displaced
IVdetached + displaced or rotated
Berndt & Hardy Grading of Osteochondritis Dissecans (OCD)

History

  • pain
  • swelling
  • instability
  • repetitive sprains

Examination

  • ↓ ROM
  • painful ROM
  • Local tenderness

Investigations

Osteochondritis Dissecans (OCD) of the Talus, ct and radiograph of osteochondritis dissecans of the talus
CT and radiograph of osteochondritis dissecans of the talus. Image by Mikael Häggström, Wikimedia Commons, CC0.
  • X-ray
    • OCD can be difficult to identify on X-ray
  • MRI
    • can define extent of lesion
    • extent of sclerosis displacement
    • whether articular cartilage is intact (fluid beneath OCD fragment denotes articular cartilage breach)

Treatment

  • Course of OCD talus is more benign in children than in adults
  • Initial treatment for types 1-3 is nonoperative with cast immobilisation + protected weightbearing
  • Type 4 lesions (or failed nonoperative treatment for types 1-3) require drilling, debridement & fixation

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.