cold foot and pain down either side of the foot

by michelle
(derbyshire)

previous history, ligament repair left outer aspect of ankle 6 years ago. i have pes planovalgus and it has been discovered that i have a 8mm osteochondral lesion in the superolateral talar dome. im experiencing a clicking sound when walking and the foot aches and feels cold. just wondered about options as im only being offered a steriod injection

RESPONSE

Hi Michelle,

I understand your symptoms but I wish I really knew a little bit more about you, primarily your age, your weight, do you smoke, are you diabetic, just to name a few.
I ask because I am concerned about the "cold foot" that you mention. This is usually caused by poor circulation particularly if it is only one foot.
To a lesser extent it could also be a sign of nerve involvement, either from an issue extending from the lower back or even perhaps a result of the surgery six years ago.
You do not mention how long this feeling has been going on, so that does not help me either.
Generally an osteochondral defect will not cause pain down either side of the foot as you mentioned in your Title. It is more of a localized pain that will prevail when the ankle goes through its range of motion.
So, I guess I am more concerned about the cold foot and pain on either side of the foot than I am about the osteochondral defect. I feel those symptoms need to be addressed first and I do not think they are coming from the talus (talar dome).
You mention that you have been offered a cortisone injection, so that tells me a doctor has examined you. Has he or she checked your circulation or at the very least have you mentioned that the foot feels cold?
If my concerns have been addressed by your doctor and there are no issues than we are back to the osteochondral defect.
You certainly could have a cortisone shot; it may or may not give you relief.
Because you say you are flat footed (pes plano valgus), you certainly could try an orthotic in your shoe. This would reduce your valgus deformity but more importantly would create a better alignment in the ankle joint and may create less irritation from the talar defect. It would be the equivalent of wearing eyeglasses to correct your eyesight. It would correct but not cure the problem.
Again, I do not know how long you have been suffering with this problem, but you could also consider immobilization of the ankle joint for perhaps six weeks to see if the pain quiets down.
Lastly, there is always surgery. Depending on the size of defect and its location it may be done arthroscopically, but there is always the possibility that the ankle joint would have to be opened up and the defect repaired that way.

Marc Mitnick DPM
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