Some ankle injuries damage the cartilage and underlying bone of the talus, the bone that sits between the shin bone and heel bone. These injuries, called osteochondral lesions of the talus, can cause ongoing ankle pain, swelling, stiffness, and difficulty with daily activities.
When a lesion is located deep along the inner or back portion of the talus, standard ankle arthroscopy may not provide enough access to treat it properly.
A medial malleolar osteotomy allows the surgeon to temporarily move the inner ankle bone to reach the damaged area, repair the lesion, and then secure the bone back into place.
Understanding Osteochondral Lesions of the Talus
The talus helps form the ankle joint and allows your foot to move up and down. Its surface is covered with smooth cartilage that helps the joint move comfortably.
An osteochondral lesion occurs when the cartilage and the bone underneath it become damaged. This often happens after an ankle sprain, fracture, or repeated stress. Some injuries cause a small area of cartilage damage, while others involve a deeper defect or a loose piece of bone and cartilage.
The location and size of the lesion help determine the best treatment. Lesions on the inner side of the talus can be difficult to reach because the medial malleolus, the bony prominence on the inside of your ankle, blocks the surgical approach.
Symptoms
Patients with osteochondral lesions may experience deep pain inside the ankle, particularly when walking, running, or participating in sports. Swelling, stiffness, tenderness, and a feeling that the ankle is giving way may also occur.
Some patients report catching or locking sensations when moving the ankle. Symptoms may improve with rest but can persist or worsen over time, especially with continued activity.
Diagnosis and Imaging
Your doctor will examine your ankle, review your symptoms, and assess your range of motion, stability, and areas of tenderness.
X-rays can identify fractures, bone spurs, and changes in ankle alignment. An MRI helps evaluate damage to the cartilage and underlying bone, while a CT scan provides a more detailed view of the size, depth, and location of the lesion.
These imaging studies help determine whether the lesion can be treated through standard arthroscopy or requires the additional exposure provided by a medial malleolar osteotomy.
Non-Surgical Treatment Options
Small, stable lesions may improve with non-surgical treatment. This can include rest, temporary immobilization in a boot or brace, anti-inflammatory medication, and physical therapy to improve ankle strength and motion.
Some patients may need to limit weight-bearing and use crutches while the ankle heals. If pain continues or imaging shows a larger or unstable lesion, surgery may be recommended.
Medial Malleolar Osteotomy Surgery
A medial malleolar osteotomy is used when the damaged area of the talus cannot be adequately reached through less invasive techniques.
The surgeon makes an incision along the inner ankle and carefully creates a controlled cut through the medial malleolus. This allows the bone to be moved temporarily, providing direct access to the damaged portion of the talus.
The underlying lesion is then treated based on its size and severity. This may involve removing damaged tissue, using drilling or microfracture techniques to stimulate healing, or placing cartilage and bone graft material to restore the damaged area.
Once the repair is complete, the medial malleolus is returned to its original position and secured with screws or a small plate. The incision is then closed.
The goal is to treat the talar lesion while restoring the normal position and stability of the ankle joint.
Recovery After Surgery
Recovery requires time because both the talar lesion and the bone cut in the medial malleolus need to heal.
Patients typically wear a cast or walking boot for approximately six to eight weeks. During the initial recovery period, you will generally need to avoid putting weight on the operated ankle and use crutches. Weight-bearing is gradually increased once your surgeon confirms that healing is progressing appropriately.
Physical therapy begins when appropriate to restore ankle motion, strength, balance, and walking mechanics. Light activities may resume around eight to twelve weeks, while returning to sports or more demanding activities may take four to six months. The timeline depends on the extent of the cartilage injury, the repair performed, and bone healing.
Swelling and stiffness can continue for several months, so following your surgeon’s recovery instructions is important.
Risks and Possible Complications
As with any surgery, medial malleolar osteotomy carries potential risks. These include infection, delayed wound healing, nerve or blood vessel injury, and problems with bone healing. The osteotomy may heal slowly or fail to heal completely, and the screws or plate can sometimes cause irritation.
There is also a risk of cartilage damage or continued ankle pain. In some cases, hardware may need to be removed after the bone has healed. Returning to strenuous activity too early can place excessive stress on the healing bone.
Long-Term Outlook
The goal of surgery is to improve access to the damaged talus, treat the cartilage and bone injury, and preserve ankle function. Many patients experience meaningful pain relief and improved mobility after appropriate treatment and rehabilitation.
The final outcome depends on the size and severity of the lesion, the condition of the surrounding cartilage, and how well the bone and repaired area heal. Gradual return to activity is important to protect the repair and reduce the risk of reinjury.
When to See a Specialist
You should have your ankle evaluated if you experience persistent pain, swelling, stiffness, or locking, particularly after an ankle sprain or fracture. Symptoms that continue despite rest, bracing, or physical therapy may indicate an underlying cartilage or bone injury.
Seek urgent medical attention if you develop severe swelling, uncontrolled pain, redness, or drainage after surgery, or if you experience a new injury that makes it difficult to move or bear weight on your ankle.
Insurance and Cost
Medial malleolar osteotomy and treatment of talar lesions may be covered by Medicare and most major insurance carriers, including Aetna, Anthem BCBS, Cigna, Empire BCBS, and UnitedHealthcare, as well as most workers’ compensation and no-fault insurance plans. Coverage depends on your specific plan and the medical necessity criteria that apply to your case.
Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs. For a full list of accepted insurance plans and patient billing information, visit our Insurance Information page.
The content on this page has been authored, edited, or approved by the doctors below, and was last reviewed for accuracy on November 12, 2026.
