I damaged the cartilage of my ankle in a football injury several years ago. I’ve quit playing because the pain is pretty bad. The surgeon I’m seeing has kind of a step-by-step plan to treat this problem starting with getting the weight off the foot. What if that doesn’t work?

Many surgeons work with a decision-making tree referred to as an algorithm. In the case of ankle pain, it’s important to determine the cause before assigning a specific treatment.

Getting weight off the joint and giving it time to heal is a wise first step for many problems. In the case of damaged joint cartilage, there isn’t a good blood supply to the area, so healing can be delayed if it occurs at all.

Damage to the cartilage can cause fissures (cracks), pits, holes, and even displace fragments of cartilage. Depending on how deep, wide, and long the lesion is, the osteochondral (bone and cartilage) defect is classified as stage one through four.

X-rays, MRIs, and CT scans each have their own grading scale but the end-result is a diagnosis that is used to determine the most appropriate treatment. With mild (early stage) disease, it may be possible to treat the problem conservatively with nonoperative care (rest, immobilization in cast or splint). Deep fissures or displaced fragments require more extensive surgical procedures.

If the OLT is free of cysts, then a simple debridement (smooth the area, remove frayed edges) may be all that’s needed. Another treatment option early on is called microfracture — after debridement, the surgeon drills tiny holes in the area of the defect down into the bone. This stimulates bleeding and a healing response.

For larger defects (or for any size defect that doesn’t respond to a more conservative approach), the lesion is filled with graft material. The donor graft may come from a bank (allograft) or from the patient (autograft).

Reconstructive procedures are not 100 per cent guaranteed. When patients fail to recover after arthroscopic procedures, it may be necessary to perform a second operation — this time with an open incision. Again, the selection of which approach to use depends on the type of lesion and stage.

Some problems just can’t be treated with reconstructive procedures. That’s when an ankle fusion or joint replacement might be more appropriate. But fusion or replacement are the end points on the algorithm and you are just at step one. Follow your surgeons directions carefully and you should have a good result with the early conservative care outlined for you.