Osteochondral lesion in a patient with sequela of club foot

Osteochondral Defects

Description of patient (type of occupation, indication of age, intensity of sport):

The patient is a boy, 16 years old, he plays tennis with a sequel of bilateral clubfoot operated years ago by another surgeon, with valgus malalignment in both feet.

History and previous treatment:

He has pain when he plays sports, 3 times a week, no swelling.

Current complaints:

He can´t play tennis without pain.

Physical examination:

Ankle valgus deformity sequela of a lot of surgeries about his club feet. No laxity and no instability.


[Picture 1 = 2]
lateral weightbearing X-rays

Additional investigation (CT/MRI):
[Picture 3]

Coronal view.
[Picture 4]

Saggital MRI shows osteochondral lesion.


Case summary:

Patient of 16 years old that he can´t play tennis without pain, previously he was operated a lot of times, he would like to improve the symptomatology.

Question(s) to this case:

I would like to know which is the best alternative:
1. Arthroscopy and treating the osteochondral lesion and calcaneous osteotomy to correct the malalignement.
2. Conservative treatment and change sport.
3. Another alternative.


Difficult case. Change sport is probably best option. Otherwise indeed calcaneal osteotomy and possibly OCD treatment. Since it looks a large lesion I would strongly consider Lift, Drill, Fill and Fix the OCD.