avn of talus --treatment and concerns--

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I have been diagnosed with AVN of the talus dome for over six months. I had an accident were a large piece of marble landed on the area of the talus almost a year ago. I have recently had surgery which entailed drilling into the affected area to possibly try to increase blood flow and resolve the AVN. At time of writing it is 2 months post surgery with still no improvement. My doc has told me it may take longer to heal or they in fact missed the area and may have to repeat the process. Does this surgery actually resolve the AVN problem or are we just clutching at straws. I am 26 years old and want to get back to my normal way of living prior to the accident. Is this indeed possible? My doc doesn't seem confident. He does not want me to use Fusion. Why? Also an ankle replacement is an other option that he does not want to look at as he says I will wear it out in 20 years and I will need a new one. Is this a bad idea for me to do as I see it working now and solving all my problems and if i have to do it again then so be it?? Am I wrong to think this?? The other option is Osteochondrial Allograft that he doesn't do and is unsure can be done on the ankle. Can this be done on the talus and is this a viable long term solution? Please help I want to be able to chase my daughter around the beach pain free !!!!!

Thank You Naples Florida

-- Mark Stevenson (canes2918@hotmail.com), May 14, 2004


AVN of the talus is a difficult condition to treat. I agree with your doctor to wait, and even try the drilling procedure again. You have nothing to lose but time and could potentially save yourself an ankle fusion or replacement. Fusion means not being able to move your ankle ever again, so I understand your doctor's hesitation. Fusion should be your last option.

-- Mesfin Lemma, M.D. (mlemma2@jhmi.edu), May 19, 2004.

i posted here several months ago, when i was also wondering about AVN in my talus. i was lucky that i avoided that, but because my doctor was so worried about my developing AVN, he kept me immobilized FOREVER. because of the extensive immobilization, i ended up with a subtalar joint autofusion -- my heel and talus grew together.

the fusion sucks. i've had 2 operations to reverse it, and it can't be fixed. i can no longer walk over uneven ground, will limp for the rest of my life, and will probably never run again. i'm 27, used to run 5x a week and rock climb 3x a week. i lost all those activities. try anything to NOT get a fusion.

-- clara (clara@nyu.edu), September 15, 2004.

I had a hawkins II talar neck FX ~2.5 yrs ago now. Internal fixation/reduction in trauma surgery w/ 16 week zero wieght bearing. 5 months of intense PT following and went back to Snowboarding 9 months after injurty. Minor signs of AVN prior to... but dome collapse after too much loading back on snowboard. 2nd surgery at just over a year post injury to "raise" collapse portion of talar dome, bone grafting, and additional hardware. 16 more weeks of 0 w/b, and still a non-union with signs of AVN... ended up zer0-to- partial wieght bearing (crutches) for 10 months. Wore EBI bone stimulator for 3 months, no significant improvements, until combined with regular accupuncture and Naturopath treament (supliments etc). Was walking again after 3 months of this treatment. Had hardware removal at 2 year anniversary of original injury, 1 year post collapse surgery repair, due to broken hardware interfering w/ ankle joint. I am now doing bikroam yoga 3-5 times per week, walking normally, took up surfing (walking on the beach!), and have relatively low pain. Still show signs of AVN, but it continues appear to be revasculating slowly.

Answer: Fusion is definate LAST RESORT. Total ankle replacement is not an option at age <50, (I'm 29 now). I suggest avoiding additional surgerys, and pursuing alternative healing solutions as I have had very positive results.

A change of lifestyle is inevitable with these types of injuries. Forced change sucks, but can lead to new sports, outlets, and opportunities.

Best of luck to you...

-- BB (snowone@gmail.com), October 15, 2004.

There is an allograft procedure for the talus bone using a cadeaver. The long term is to relieve pain and return to full function of ankle. I am having this surgery at Duke in Durham, NC. There are other solutions..drilling would not work for me my lesion is to large to do drilling, and I had to consider all options and seen two experienced surgeons in the field of allografts of talus...with great results and many articles..Best of luck to you.

-- Gina (kardiacrn@aol.com), December 06, 2004.

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