Description of patient (type of occupation, indication of age, intensity of sport):
42 year old male, hard worker.
History and previous treatment:
12 years ago he had a talus fracture, treated with two screws.
One year ago increasing pain and dorsi-flexion limitation.
First treatment screws removal
Current complaints:
Pain at subtalar joint, lateral side.
Physical examination:
Cavus foot, pain during inversion-subversion and pronation-supination motion. 15 degrees limitation of dorsal and plantar flexion. Not pain during ankle motion
Radiology:
X-ray:
[Picture 1 - 3]
Additional investigation (CT/MRI):
[Picture 4 + 5]
Images:
Case summary:
Osteonecrosis of the medial aspect of the talus (talus fracture 12 y ago). Varus alignment of the ankle joint, but pain on the lateral side of the subtalar joint.
Question(s) to this case:
what is the best surgical option? Sub-talar arthodesis as first step?
Heel osteotomy?
Expert:
varus alignment in the ankle joint. Pain on the lateral side can be because of capsular/ligament traction or more likely to subtalar compression(compensatory vagust to the varus in ankle joint.
X-Ray and CT show degeneration in ankle and subtalar joint: varus malalignment.
Lateralising calcaneal osteotomy ( 7.5 or 10 mm) would be my first step: it will normalise the forces in both joints.