Coronal Plane Alignment Abnormalities in Medial/Lateral Osteochondral Lesion of the Talus

Clarifying whether osteochondral lesions of the talus associate with coronal plane ankle and hindfoot alignment abnormalities is critical for guiding surgical decisions such as supramalleolar or calcaneal osteotomy. This retrospective case series included 142 consecutive osteochondral lesion patients treated between August 2014 and April 2019, with 111 enrolled after strict inclusion and exclusion criteria. Patient data were carefully extracted and cross-checked, and lesion location was determined via computed tomography or magnetic resonance imaging, grouping patients into 91 medial and 20 lateral cases. Standard weight-bearing radiographs were used to measure tibial anterior surface angle, tibial axis–medial malleolus angle, tibio-talar angle, tibial lateral surface angle, hindfoot alignment angle, and lesion area. Inter-rater reliability assessed by intraclass correlation coefficient (≥ 0.85) showed excellent agreement. The medial group had a significantly older mean age (48.32 vs. 30.25 years, p < 0.01), greater hindfoot varus, larger tibial axis–medial malleolus angle, and smaller lesion areas (p < 0.05), while no significant differences were found in tibial anterior surface angle, tibio-talar angle, or tibial lateral surface angle. These findings indicate that medial osteochondral lesions of the talus correlate with hindfoot varus, emphasizing the need to assess and adjust alignment during clinical treatment.