Korean J Pain.  2013 Apr;26(2):164-168. 10.3344/kjp.2013.26.2.164.

Searching for Hidden, Painful Osteochondral Lesions of the Ankle in Patients with Chronic Lower Limb Pain: Two Case Reports

• Ri HS
• Lee DH
• Kim KH

• KMID: 1978662
• DOI: http://doi.org/10.3344/kjp.2013.26.2.164

Abstract

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.

Keyword

ankle; cementoplasty; complex regional pain syndrome; osteochondritis dissecans; thromboangiitis obliterans

MeSH Terms

Animals
Ankle
Cementoplasty
Chronic Pain
Cold Temperature
Crutches
Female
Ganglion Cysts
Humans
Hyperalgesia
Leg
Lower Extremity
Neuralgia
Osteochondritis Dissecans
Talus
Thromboangiitis Obliterans
Tibia
Troleandomycin
Walking
Weight-Bearing
Troleandomycin

Figure

• 

  Fig. 1 Preoperative magnetic resonance images showed osteochondral lesions (red circle) of the left talus sized 11.9 × 6.0 × 15.0 mm (A) and the left tibia sized 9.4 × 17.1 × 22.5 mm (B).

• 

  Fig. 2 Intraoperative fluoroscopic images. (Left) A 26-gauge needle was inserted to infuse local anesthetics into the skin over the cyst on the left talus (A) or tibia (B). (Middle) Contrast medium was injected into the osteochondral lesion (OCL) of the left talus (A) or tibia (B) before injection of bone cement, respectively. (Right) The OCLs were filled with bone cement.

• 

  Fig. 3 Postoperative computed tomography images. The left talus (A) and tibia (B) were filled with the bone cement (blue circle).

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