Running Away From The Diagnosis - Page #4
 

Working Diagnosis:
Left Talar Dome Osteochondral Defect

Treatment:
Diagnostic injection followed by functional/exertional testing performed to confirm source of pain. Once confirmed, patient was referred to Orthopedic Surgery where he underwent arthroscopic microfracture and micronized allogenic cartilage scaffold placement.

Outcome:
Soldier had graded return to activity with 4 weeks non-weight bearing in CAM boot followed by 4 weeks weight bearing in CAM boot with subsequent physical therapy. Following surgery and rehab, the soldier returned to duty with improvement in symptoms.

Author's Comments:
The significance of this case is threefold. It demonstrates an atypical presentation of a talar dome OCD. It also highlights the utility of ultrasound guided diagnostic injections. Such procedures can provide useful clinical information that assist in subsequent treatment plans. Lastly, it demonstrates the utility of functional/exertional testing when symptoms are absent with bedside exam alone.

Editor's Comments:
This case nicely outlines that ultrasound-guided injections can help in the decision-making for surgical treatment and surgical planning, especially if the source of pain is not completely elucidated by physical and imaging examination. (1) In this particular case, if the injection with functional/exertional testing would not have improved the soldier's pain, alternative diagnoses would have been reviewed. Since the injection led to an improvement in pain, the talar dome OCD lesion was felt to be the pain generator and repair was decided.

References:
1. Netto, et al. Diagnostic and therapeutic injections of the foot and ankle - An overview. Foot and Ankle Surgery. Volume 24, Issue 2, April 2018, Pages 99-106.

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