Osteochondral Lesion of the Talus: fragment fixation or microfracture
Recovery after surgery for a talar osteochondral lesion, with progression matched to the procedure.
Protection, return to weight bearing and impact are separate stages; timing varies by procedure.
For physiotherapists: adapt exercises, dosage and progression to the injury or procedure, protection, permitted loading and movement; check clinical criteria, not elapsed time alone.
Scope and before starting
For talar fixation or marrow stimulation/drilling. Do not use a common timetable when a malleolar osteotomy, ligament repair or graft is added: the surgeon must specify the additional protection.
Before starting
Record procedure, site/size and associated operations. Record the surgeon’s loading, brace/cast and movement instructions.
Progression
Non-weight-bearing duration differs between procedures. No pain and a healed wound do not by themselves clear loading or impact. Functional checks below are a practical checklist adapted from the sources, not validated paediatric tests.
Perform only the exercises selected for you, at the prescribed dose. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
Do not try running or hopping to check whether you have healed.
Report pain or swelling that develops after the session too.
Treatment phases and illustrated exercises
Exercises are shown in their assigned starting phase, with their instructions and precautions. The physiotherapist selects them for the individual plan; the complete protocol is not a prescription to perform them all.
Respect the minimum times and protection required for the procedure. Time alone does not authorise progression: the treating team checks the clinical criteria.
Preparation for surgery (elective cases)
Short educational and functional phase in elective cases; not applicable to acute cases needing immediate treatment.
Goals
Crutch training with full or partial off-loading as directed.
Swelling and pain control.
Maintenance of allowed ankle and foot mobility.
Maintenance of hip, knee and contralateral limb strength.
Preparation plan
Practical crutch trial with the planned off-loading, including stairs.
Education on brace/boot, off-loading duration and school organisation.
Precautions
Acute, salvageable osteochondral fragment: fixation must not be delayed.
Joint locking or worsening mechanical symptoms.
Criteria checked by the treating team
Safe crutch use with the planned weight bearing.
Swelling and pain controlled.
Allowed mobility maintained.
Family informed about procedure and restrictions.
When preparation is useful
Only in elective cases, typically chronic symptomatic lesions of the talar dome.
Aggressive ankle prehabilitation is not needed: the aim is to prepare off-loading, home management and allowed range of motion.
Fragment fixation, microfracture/marrow stimulation and other procedures have different restrictions, explained before surgery.
Home and school preparation
Prepare clear pathways at home and a place to keep the leg elevated.
Check stairs, bathroom and school transport with the planned off-loading.
Inform the school: accessible desk, temporary PE exemption, backpack management.
Crutch and weight-bearing training
Short educational and functional phase in elective cases; not applicable to acute cases needing immediate treatment.
Try the crutches before surgery, with correct height and the weight-bearing status set by the surgeon.
Practise on level ground, stairs and the entrance to your home, with someone assisting.
Also practise sitting, standing and moving in the bathroom while respecting the planned loading restrictions.
Dose and progression: At least one training session before admission; repeat until the technique is safe.
Active ankle mobility
Short educational and functional phase in elective cases; not applicable to acute cases needing immediate treatment.
Seated or lying, move the ankle into flexion, extension and slow circles, within the pain-free range.
Keep the movement smooth, without forcing the painful end range.
Dose and progression: Indicative: 10-15 movements per direction, 2-3 times a day.
1. Protection
Prescribed initial period
Goals
Protect the procedure and control swelling.
Physiotherapy plan
Crutch training, free-toe movement and static hip/thigh contractions without ankle loading.
Ankle up/down movement only if motion and brace removal are allowed.
Precautions
Do not exceed prescribed loading; no bands or forced movement.
Criteria the treating team checks before progression
Wound and symptoms controlled.
Motion permitted by the surgeon.
Illustrated exercise options
Unloaded ankle motion
Only after clearance for motion and brace removal for this exercise.
With the leg supported and foot free, slowly move the foot towards and away from you within the permitted range.
The figure shows the two directions, not the range to achieve. Do not use bands or manual pressure.
Stop for deep pain; do not add rotations unless authorised.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
2. Protected movement
Before loading recovery
Goals
Restore comfortable motion without joint irritation.
Physiotherapy plan
Slow active movements in permitted directions; gentle ankle isometrics only if cleared, without pushing against a brace or cast.
Maintain hip and knee strength without ankle loading.
Precautions
No forced dorsiflexion or movement through deep pain.
Criteria the treating team checks before progression
Permitted range tolerated without reactive swelling.
Loading and strengthening cleared.
3. Walking and strength
After loading clearance
Goals
Restore gait and push-off.
Physiotherapy plan
Increase loading and reduce aids without limping.
After loading and strengthening clearance, progress from static to dynamic strength: band work in permitted directions and supported bilateral calf raises; gentle weight-bearing mobility only if indicated.
Precautions
Do not force end range; no running or jumping.
Criteria the treating team checks before progression
Walking and selected work without deep pain or increasing swelling.
Check supported bilateral calf raises and single-leg stance only if cleared: record movement quality and later symptoms.
Illustrated exercise options
Walking with crutches and prescribed foot contact
Only when some foot contact is permitted. The figure does not show a fully non-weight-bearing pattern: if contact is prohibited, you need specific instruction.
Have the crutches adjusted and learn the sequence appropriate to your loading limit from the physiotherapist.
Practise on a level, clear path with an adult nearby; the foot contacts the ground only as prescribed.
Stop if limping, pain or fatigue increase. Practise stairs with assistance; do not stop using crutches solely because pain decreases.
Dose and progression: Agreed short distances with rests; duration and frequency depend on prescribed loading and gait quality.
Gentle knee-to-wall mobility
Only for a dorsiflexion limitation assessed by the physiotherapist, after clearance for loading and motion in this position.
In the half-kneeling position shown, place the treated foot forwards; use your hands on the wall for control.
Move the knee a little towards the wall, keeping the heel down and staying within the permitted range.
Do not aim for a preset distance or push through pain or blocking at the front of the ankle. Return slowly to the starting position.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Resisted ankle plantarflexion
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
Sit with the leg supported, loop the band around the forefoot and hold the ends towards your body as shown.
Slowly point the foot down within the permitted range, then return with control; the band must not press painfully on the foot.
The arrow shows only pointing the foot down: do not use one anchor for all four directions.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Resisted ankle eversion
Only after clearance for resisted eversion and demonstration by the physiotherapist.
Sit with the legs supported; have the band positioned to pull inwards, as shown.
Move the forefoot slightly outwards while keeping the leg still; the movement should not come from the hip.
Return slowly without letting the band snap back. Do not force end range; stop for deep pain.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Supported double-leg calf raises
Only after clearance for full weight bearing and calf strengthening.
On a level floor, place your hands on a stable support as illustrated.
With both feet, slowly raise the heels and lower them with control.
Do not independently progress to one leg or a step edge. Stop for joint pain and monitor the subsequent response.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
4. Functional control
Before impact
Goals
Recover strength, balance and loading tolerance.
Physiotherapy plan
Progress calf raises and supported firm-ground balance, then single-leg balance if well controlled; unstable surfaces only if useful and supervised.
Non-impact conditioning and functional assessment.
Precautions
No hopping tests before impact clearance.
Criteria the treating team checks before progression
Record quality and number of calf raises, and duration and control of firm-ground single-leg balance; compare across reviews without later deep pain or swelling.
Healing assessment and surgeon clearance.
Illustrated exercise options
Firm-ground balance
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
On firm ground with eyes open, slightly lift the other foot while keeping the pelvis level.
Keep one hand on a stable support as illustrated; an adult must be able to assist the child.
Put the free foot down before losing control. Do not add cushions, closed eyes or perturbations.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Balance on a soft surface
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
Perform this exercise under direct physiotherapy supervision, after recovering safe single-leg support on firm ground and receiving clearance.
On the stable foam pad selected by the physiotherapist, keep your eyes open, the knee slightly bent and a stable hand support within reach.
Put the other foot down if you lose control. Do not add eyes-closed work or perturbations independently; at home use the firm-ground version prescribed by your physiotherapist.
Dose and progression: Supervised session only; duration matched to control. Not an automatic home prescription.
5. Impact and sport
After specific clearance
Goals
Resume running and sporting tasks.
Physiotherapy plan
Only after favorable lesion review and impact clearance: interval straight-line running, then small hops with controlled landings, followed by deceleration and direction changes.
Partial then full training before competition.
Precautions
Deep pain or new swelling requires stopping progression and reassessment.
Criteria the treating team checks at the end of the pathway
Full training tolerated without a joint reaction.
Return agreed with the treating team.
Illustrated exercise options
Straight-line walk–run progression
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
On level, even ground, alternate walking with short bouts of easy straight-line jogging according to the physiotherapist’s programme.
Keep an even gait without limping. Begin without sprinting, hills, jumping or direction changes.
Increase one demand at a time. If joint pain, limping or swelling occurs during the work or the next day, stop the progression and report it to the physiotherapist.
Dose and progression: Run/walk intervals, duration and recovery set by the physiotherapist for the procedure, age and response to loading; the phase does not provide an automatic dose.
Small two-foot forward hops
Only after jump clearance and an on-the-spot landing check by the physiotherapist. The figure shows the forward progression, to introduce with them.
With the physiotherapist, make one small two-foot forward hop on a firm, even surface, as illustrated.
Land on both feet with control and pause before repeating. The physiotherapist selects distance and number of hops; no sideways or single-leg hops without further instruction.
Stop for pain or loss of control and report pain or swelling afterwards.
Dose and progression: Initial attempts and dose selected by the physiotherapist; increase only after checking the subsequent response.
Planned braking and direction changes
After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
With the physiotherapist, begin with controlled slowing and wide turns at low speed in agreed directions.
Control the trunk, knee and foot. Increase speed and turning angle separately; sharp, reactive or contact movements require further assessment.
Stop for pain, giving way or limping; also report swelling or pain after the session and the next day.
Dose and progression: Intervals, rests and recovery days selected for age, sport and previous level. No independent maximal tests; tolerate full training before competition.
Return to sport / full activity
The procedure, associated operations and recovery determine timing, not a sprain timetable.
Healing assessed and impact cleared.
Document motion, calf raises and single-leg control; after impact clearance, assess landings and deceleration without joint reaction.
Full training without subsequent deep pain or swelling.
Warning signs: stop and contact the treating team
Fever, increasing wound redness or warmth, or drainage: contact the surgical team the same day, even without fever.
Increasing pain, new locking, persistent swelling or loss of regained movement: stop progression and arrange reassessment.
A cold or pale foot, reduced sensation or severe pain under a cast/brace needs urgent assessment. Breathing difficulty or chest pain is an emergency.
Guidelines and literature
Sources inform the pathway; they do not validate every dose for an individual child.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
Select the exact phase assigned by the treating team, then choose each prescribed activity. No exercise is selected automatically. The team sets loading, movement, aids, dose and frequency; missing instructions must be completed before use, including by hand.
Browse illustrated exercise options
Short educational and functional phase in elective cases; not applicable to acute cases needing immediate treatment.
Short educational and functional phase in elective cases; not applicable to acute cases needing immediate treatment.
Only after clearance for motion and brace removal for this exercise.
Only when some foot contact is permitted. The figure does not show a fully non-weight-bearing pattern: if contact is prohibited, you need specific instruction.
Only for a dorsiflexion limitation assessed by the physiotherapist, after clearance for loading and motion in this position.
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
Only after clearance for resisted eversion and demonstration by the physiotherapist.
Only after clearance for full weight bearing and calf strengthening.
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
Only after jump clearance and an on-the-spot landing check by the physiotherapist. The figure shows the forward progression, to introduce with them.
After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
Choose the current phase to prepare a printable sheet.
Phase safety summary ·
COMPLETE BEFORE EXERCISING — The treating team must complete the blank instructions, including handwritten entries, before this sheet is used.
Follow the assigned phase and instructions confirmed by the treating team; filling in fields does not authorise exercise.
No exercises assigned. This is a safety summary, not a complete exercise prescription.
Individual instructions for this phase
Loading (how much weight on the leg): ________________________________
Brace and crutches: ________________________________
Procedure and starting conditions
Before starting: Record procedure, site/size and associated operations. Record the surgeon’s loading, brace/cast and movement instructions.
Progression: Non-weight-bearing duration differs between procedures. No pain and a healed wound do not by themselves clear loading or impact. Functional checks below are a practical checklist adapted from the sources, not validated paediatric tests.
Advice before starting
Perform only the exercises selected for you, at the prescribed dose. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
Do not try running or hopping to check whether you have healed.
Report pain or swelling that develops after the session too.
Warning signs: stop and contact the treating team
Fever, increasing wound redness or warmth, or drainage: contact the surgical team the same day, even without fever.
Increasing pain, new locking, persistent swelling or loss of regained movement: stop progression and arrange reassessment.
A cold or pale foot, reduced sensation or severe pain under a cast/brace needs urgent assessment. Breathing difficulty or chest pain is an emergency.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
