Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My seven-year-old daughter has developed some pain and tenderness in the left ankle before twenty days back. She avoided doing weight-bearing on that side due to pain. She does not have a history of trauma and significant medical history. She has mild eczema and it has improved over a period of time. We took an MRI and it showed a 7 mm osteochondral defect involved in the talar dome with minimal edema. It appeared stable and there is no joint effusion or synovial thickening. We consulted an orthopedic and he suggested to avoid doing excessive physical activities as it can cause burden to the ankles. We tried to reduce her mobility as much as possible. She is at home now with online classes.
Her discomfort and tenderness in the medial malleolus have got reduced. The mild pain present on the plantar extension has got reduced. We consulted an orthopedician again a couple of days back and he told us that she can do all normal activities except activities like jumping and dancing. He advised to have a follow-up MRI after six months. She is not taking medications now. I want a second opinion regarding her present condition. Is the recommended management is fine or does she need more rest? Do we need to take any other precautions? Does she need to take Vitamin D and calcium in her diet to fasten the healing process? Can she have long term implications after grown? Can her activity become restricted?
Hi,
Welcome to icliniq.com.
I have gone through your daughter's MRI report (attachment removed to protect patient identity). There is an osteochondral defect in the medial talar dome. These are uncommon lesions seen on MRI (magnetic resonance imaging) due to ankle sprain. This is an early lesion at stage 2 with a partial rent in the cartilage cap and I would have treated this in six weeks with touch bearing for balance. Following this graduated weight-bearing, a full pain-free comfortable weight-bearing is possible. These are usually incidental findings seen in children with pivoting dancing and jumping children without a single trauma. The absence of trauma is uncommon and it represents multiple minor injuries and it leads to obstruction of blood supply.
Taking vitamin D supplementation is never harmful and check the blood level for vitamin D deficiency. You cannot have a long term issue if the lesion heals without progression. On progression, the problem can move from stage 2 to stage 3 or 4 with a displacement of complete cartilage cap tear and fluid seeping into the junction between the bed and dead bone. So close observation is necessary till the healing is wise with activity restrictions. Repeat MRI after six months or if the symptoms recur.
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Patient's Query
Thank you doctor,
The orthopedic consultant is against putting a cast. I have a wheelchair at home and she uses it to avoid weight-bearing. She will be at home for two months due to pandemic. Is this enough for healing or do I need to consult another orthopedician for cast?
Hi,
Welcome back to icliniq.com.
You have made arrangements for non-weight-bearing mobilization at home and you can maintain it. It serves a lot. Change it only when you do not see improvements.
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Orthopedician and Traumatology
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