Talonavicular osteoarthritis and talar OCD

Osteochondral Defects

Description of patient (type of occupation, indication of age, intensity of sport):

A 61-years-old female. Works at home.

History and previous treatment:

Rheumatoid arthritis. Both left and right hip prosthesis on 2006. Actually no pain on other joint other then left foot and ankle.

Current complaints:

Pain on her left foot. Impossibility to walk without pain.

Physical examination:

Pain walking but without crutches. Pain at talonavicular joint


[Picture 1]
Talonavicular osteoarthritis.

Additional investigation (CT/MRI):
[Picture 2 - 5]

CT: Talonavicular osteoarthritis and osteochondral lesion on talus (Ankle joint).
[Picture 2 - 4]

MRI: both Talonavicular osteoarthritis and tibio talar OCD.
[Picture 5]


Case summary:

61 years old lady with history of rheumatoid arthritis prosthesis on her left and right hip. Pain on her left foot and ankle at level of talonavicular joint

Question(s) to this case:

How to treat? Both pathologies or only one?


Her problem is the talonavicular arthrosis. The OCD is not likely to be part of her symptoms: this defect exist probably since her youth and did never give problems before. She did not have accident so unlikely this is symptomatic. I take it there is no bone oedema on T2 or STIR? If you did not make a T2 or STIR, my advice is to make one. If there is no or insignificant bone marrow oedema at the Talat OCD then my advice would be to only perform talonavicular arthrodesis.