Today on the Doc On The Run Podcast we’re talking about osteochondral defects in runners.
A few minutes ago I was on a second opinion telemedicine call with runner who was told he had an MRI showing an “osteochondral defect.”
The doctor told him to stop running.
If a joint surface gets damage, you may develop a little soft-spot called an “osteochondral defect.”
Just because you have an osteochondral defect, it doesn’t necessarily mean you have to stop running, but you do need to figure out whether or not it’s actually a problem that could get worse if you don’t address it.
In this episode, we’re just talking about osteochondral defects and what they really are, because if you’ve had an issue, whether it’s in your ankle or your big toe joint or your calcaneocuboid joint or some other place, the doctor may have told you, you have this thing called an “osteochondral defect.” What this really means is when you think about the word defect, obviously that’s something wrong. There’s something missing.
“Osteo” means bone. “Chondral” means cartilage. So, all “osteochonral defect” means is that inside the joint, you’ve got bone, where two bones bump up against each other. That’s what a joint is and then the surfaces of the bones, where they bump up against each other, are covered with cartilage. Sometimes you get a defect where the bone is cracked and the cartilage is torn and that’s a really bad osteochondral defect, where not only is the cartilage damaged, but the bone underneath it is damaged as well.
Sometimes you can get a thing that we call an osteochondral defect, where you really have a cyst or a defect in the bone, that’s kind of dissolved and soft, right under the cartilage and then the cartilage is kind of moving a little bit, kind of like a trampoline, over that hollow spot in the bone and that causes pain or discomfort.
Osteochondral defects sometimes show up on an x-ray and they’re asymptomatic. Sometimes they show up on an MRI and they’re asymptomatic. I had one that I found in someone’s ankle on an MRI, and she had a nerve issue in her foot and of course, I got a call from the radiologist saying, “Oh man, there’s a huge osteochondral defect in this woman’s ankle. You’re going to have to scope that thing and backfill it or something. It looks terrible. You have to do surgery and fix that.”
Well, she actually had no pain in her ankle at all. She had no trouble with her ankle at all, yet she had this thing looked really ominous on her MRI.
Just because you have an osteochondral defect, it doesn’t mean the end of the road for you necessarily. It doesn’t mean you have to stop running, but you do need to figure out whether or not it’s actually a problem that could get worse if you don’t address it. There can be a huge range of trouble with osteochondral defects from very small ones in the big toe joint, to rather large ones in the ankle joint, and sometimes they need surgery, but a lot of times they don’t.
So it’s always important to figure out what you can do to actually redistribute the pressure and take irritation away from that thing, to figure out whether or not that’s really causing the problem.
Always get a second opinion and don’t freak out just because you get an x-ray, or an MRI report or something, that says you have an osteochondral defect. You got to figure out what it really means.
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Go grab your seat now. I’ll see you in the training.