Left Ankle Bone Changes

In 1997, I suffered a talus bone fracture on left ankle and wore an AFL leg/ankle brace. In early 2005, radiographs documented the fractured had bonded, so I weaned out of the AFO and started physical therapy to strengthen the left ankle and tendons in both legs. In May 2007, a CT scan documented evidence of cystic changes in the talus, cystic structures that are well corticated and an osteochondral defect on the medial aspect of the talar joint. Cystic changes are also noted in the calcaneus, which have benign characteristics and in the distal fibula. "All changes are believed to be due to the old trauma to the ankle joint". The ankle mortise is not widened. The tarsonavicular also shows a well corticated cystic change compatible with degenerative arthritis. The joint spaces are relatively we preserved. Minimal spurring is noted in the lateral and medial malleoli with a small separate bony fragment at the tip of the fibular styloid compatible with old healed trauma deformity as well.
IMPRESSIONS: Osteochondral defect in the talar dome and extensive cystic changes in the tarsal bones described with degenerative osteoarthritis.

The Orthopedic Surgeon recommends surgery to fill the (3) open holes and to pin the ankle bones, however, due to my age of 65 with chronic upper and lower back pain, hypertension, episodes of (undiagnosed) dizziness, 5' 10" tall overweight 280 Lbs., I am not a good surgical candidate, therefore, if I continue with little to no pain from that left tala area, the Ortho suggested staying in the AFL leg brace. (Please advice)

Rear end Accident: The talus fracture was the result of a 1997 rear-end vehicle accident, however, it is the second rear-end accident in late 2005, which may have caused the changes identified in the radiograph reading above. (Please advise)

Also, please advise relating to the Three (3) holes (osteochondral defect) in the taula and beyond the joints within the joining bones which have benign Cystic changes.
Sincerely,
Lightrudy          

[Kevin Pho, MD]

This isn't really a question that belongs in the gastroenterology forum.

I am not an orthopedic surgeon, so my insight into this question is limited.

If you are not a good surgical candidate, then the risks of the surgery may outweigh the benefits.  In that case, I agree with the conservative approach, including physical therapy.  You can consider a physiatry (rehabilitation MD) referral to help manage pain.  

Regarding the bony changes, a bone scan or MRI can be considered of the area to ensure this isn't cancer-related.  

These options can be discussed with your personal physician, or in conjunction with another orthopedic opinion.

Followup with your physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[lizziecee]

I think you have posted in the wrong forum - this is a gastroenterology/liver disease forum. Sounds as if you need advice from an orthopaedic doctor.
I would inform the moderator and ask for a credit, and then post on an appropriate site for your problem.  I don't think Dr. Pho can answer your questions.
Take care, Liz.