A 59-years old male patient presented with weight-bearing induced pain in the right ankle during one year. He has a history of alcohol abuse with polyneuropathy, nicotine abuse, diabetes, osteoporosis and avascular necrosis of both hips. He was diagnosed for avascular necrosis of the talus with cast immobilization and a walker.

Picture 1 & 2: The MRI shows extensive avascular necrosis after infarction of the talus combined with a subchondral fracture (blue ellipse). Furthermore, expanded infarctions within fibula, tibia, calcaneus, cuboid, cuneiforme and metatarsalia without mechanical implications (encircled red).

In general the term bone infarction refers to focal necrotic lesions of the bone and bone marrow within the metaphysis and diaphysis. Bone infarction has no mechenical consequences. When referring to subchondral osteonecrotic lesions the term avascular necrosis should be used. Avascular necrosis has mechanical consequences since loading can result in bone collaps.

Picture 3: Coronal view of the MRI shows a subchondral fracture of the talus (red ellipse).

Considering the history, complaints and desire of the patient we continued conservative treatment. We referred the patient to an endocrinologist to explore the possible underlying cause of the bone infarctions.