Clarifying whether osteochondral lesions of the talus are associated 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 patients with osteochondral lesions treated between August 2014 and April 2019, with 111 patients met the inclusion and exclusion criteria and were enrolled finally. Patient data were carefully extracted and cross-checked, and the 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 the 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 coefficients (≥ 0.85) showed excellent agreement. The medial group had a significantly older mean age (48.32 vs. 30.25 y, p < 0.01), greater hindfoot varus, larger tibial axis–medial malleolus angle, and smaller lesion area (p < 0.05), while no significant differences were found in the 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.

Received: 02 September 2025

Accepted after revision: 12 May 2026

Accepted Manuscript online:
13 May 2026

Article published online:
03 June 2026

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