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J Acupunct Res > Volume 33(2); 2016 > Article
Park, Kim, Ahn, Jo, Kim, Kim, and Lee: A Case Report of Osteochondral Lesions of the Left Talus after Ankle Sprain Treated with Complex Traditional Korean Medical Care

Abstract

Objectives:

The purpose of this report is to introduce a case of osteochondral lesions of the left talus caused by ankle sprain and suggest complex traditional Korean medical care with warm needling therapy as a possible method of conservative treatment.

Methods:

A 20-year-old male with osteochondral lesions of the left talus complaining of ankle pain and restricted range of movement was treated mainly with warm needling therapy and other combined Korean medicine therapy from January 5, 2015 to January 12, 2015. Improvements of symptoms were measured by American Orthopaedic Foot & Ankle Society Score (AOFAS Score), Visual Analog Scale (VAS) and Range of movement (ROM).

Results:

During 8 days of treatment, the patient showed gradual improvement in AOFAS score, VAS at rest and at weight bearing position, as well as ROM of the ankle.

Conclusion:

According to the result, warm needling therapy is a possible conservative treatment for osteochondral lesions of the talus. Further studies are needed regarding possible long-term effects.

Fig. 1
Coronal view of left ankle MRI T2 Weighted Fat suppressed MRI image shows high signal intensity area at posteromedial lesion
acup-33-2-181f1.gif
Fig. 2
Change in AOFAS Score
acup-33-2-181f2.gif
Fig. 3
Change in VAS scores of pain at rest and under weight-bearing state
acup-33-2-181f3.gif
Fig. 4
Picture taken on January 5, 2015, under plantarflexion state of both feet
acup-33-2-181f4.gif
Fig. 5
Picture taken on January 12, 2015, under plantarflexion state of both feet
acup-33-2-181f5.gif
Table 1
American Orthopaedic Foot and Ankle Society Score(AOFAS score)
Parameter Point
Pain

None 40
Mild, occasional 30
Moderate, daily 20
Severe, almost always present 0

Function(activity limitations, support requirement)

No limitations, no support 10
No limitation of daily activities, limitation of recreational activities, no support 7
Limited daily and recreational activities, cane 4
Severe limitation of daily and recreational activities, walker, crutches, wheelchair, brace 0

Maximum walking distance(blocks)

>6 5
04 – 06 4
01 – 03 2
<1 0

Walking surfaces

No difficulty on any surface 5
Some difficulty on uneven terrain, stairs, inclines, ladders 3
Severe difficulty on uneven terrain, stairs, inclines, ladders 0

Gait abnormality

None, slight 8
Obvious 4
Marked 0

Sagittal motion(flexion plus extension)

Normal or mild restriction(≥30°) 8
Moderate restriction(15° – 29°) 4
Severe restriction(<15°) 0

Hindfoot motion(inversion plus eversion)

Normal or mild restriction(75 – 100 % normal) 6
Moderate restriction(75 – 100 % normal) 3
Severe restriction(< 25 % normal) 0

Ankle-hindfoot stability(anteroposterior, varus-valgus)

Stable 8
Definitely unstable 0

Alignment

Good, plantigrade foot, ankle-hindfoot well aligned 10
Fair, plantigrade foot, some degree of ankle-hindfoot malalignment observed, no symptoms 5
Poor, non-plantigrade foot, severe malalignment, symptoms 0

IV. References

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