Conservatively Managed Osteochondral Lesion of the Talus With a Subchondral Cyst: A Case Report

Osteochondral lesions of the talus (OLT) are increasingly recognized as resulting from trauma in a broad sense, including repetitive microtrauma, yet detailed reports of lesions accompanied by a subchondral bone cyst that are managed conservatively alone remain scarce, and no consensus exists regarding their optimal management.We report the case of a 59-year-old woman with chronic right ankle pain that had not improved despite prior follow-up and who had no clear history of trauma.Examination revealed no swelling, tenderness, or pain on supination.Plain radiography and MRI demonstrated a subchondral cystic lesion with bone marrow edema on the medial talar dome, corresponding to a Scranton stage V, Anderson stage IIA osteochondral lesion.Given tolerable symptoms, small cyst size, and absence of cartilage damage on MRI, conservative management with outpatient observation was planned; however, the patient did not return for scheduled follow-up.She re-presented after a prolonged interval, and follow-up radiography showed no significant progression of the lesion.Although follow-up imaging in this case showed no significant progression of the lesion, prior literature indicates that radiographic progression can occur even in patients with favorable clinical symptoms, underscoring the importance of sustained clinical and radiographic follow-up in patients with OLT managed conservatively, even when early symptoms and imaging appear reassuring.