Ongoing ankle and foot problems

[PedroH]

I'll try and condense this as much as possible. Had tib/fib fractures- including malleolar fractures-16 months ago.I had ORIF w/insertion of tibial nail within 48hours. 5months later had bone graft done on my fibula. I have always had pain in my ankle and have some numbness on the dorsom of my foot. Through routine xrays it was noted by a radiologist that I may have signs of AVN of the talus.-CT scan was ordered Talar AVN confirmed.Was sent to a new specialist who said that AVN was unlikely with my kind of injury and sent me on my way. Now my original surgeon who is at a loss for what my problem may be feels that I may be having a reaction to the metal hardware so booked me for removal in June.  I don't know which way to turn. My foot is getting flatter by the day and my leg is wasting away. I had asked for an MRI but was told that he didn't know what he was looking for so it would be a waste to get one.  What could they have possibly of seen in the CT that was not AVN?     Any advice would be greatly appreciated.  I live in Canada so third and fourth opinions don't really happen.  Thanks so much for your time.

[PedroH]

Just a quick question.- I still don't have an appt.w/ my surgeon.-My foot is getting flatter by the day,can I wear an arch support in just one shoe?Or is there a special kind of shoe I should be wearing? Again,I thank you!

[PedroH]

I just wanted to tell you how much I appreciate the time you have given in trying to help me with my case.- it must be incredibly hard to help with no scans,evaluations etc..- I will continue to try and find answers here. Worst case scenerio, I have to come to the U.S. for treatment.  Again, you have been very helpful in pointing me in the right direction and it is greatly appreciated.       Take Care

[Yena H Do, DPM]

a radiologist is usually better at reading an MRI than a physician (they do this all day!)
i would push for another surgeon.  i know that it is difficult to go to another doctor.  but, it could unravel the problem.  make sure you go to a foot and ankle specialist.  the IM nail could cause irritation if it is not flush and protruding down from the tibia and butting up against the talar dome (top of the talus).  sometimes, these nails can also cause pain to the knee or a varus/valgus deformity of the leg if the nail was not placed straight.
taking out hardware can minimize pain...but it sounds like you may have another problem here : talar AVN as concluded by the radiologist.  i would speak to the surgeon again and discuss your concerns.  ask why he/she disagrees with the radiologist.  if you have ankle pain and the IM nail is clearly far from the tibial plafond (base of the tibia bone), there is more indication that you may have talar necrosis (AVN).   sorry i cannot comment more.  it is difficult to do without seeing you and all your tests.
I like to use external fixations for some of these fractures, or perform an open reduction vs IM nailing down the tibial shaft.

[PedroH]

Thank you so much for your time.  My big query is that even though the radiologist confirmed AVN, my specialists  disagree therefore, sweeping that diagnosis under the rug. Could the radiologist have made such a mistake? At what point will my ankle collapse if AVN is indeed what I have and I'm not being treated?  I hate having to second guess my surgeons but I'm at a loss.How can one have such conflicting opinions?   Again, I thank you for your time in helping me put my puzzle together!

[Yena H Do, DPM]

AVN (avascular necrosis) of the talus means some areas of the bone is dying.  the talus has no muscle attachments and has a higher incident for AVN than other bones in the feet when an injury occurs.  this can happen with high impact falls, sprains, and fractures to the ankle joint.  A CT scan will light up normally when there is normal bone.  if the bone is dying, there will be darkness to that particular site.  If you were diagnosed with an AVN, you need to be in a cast and non-weight bearing to the foot.  A bone stimulator can also help stimulate healing in your case. I would ask the original surgeon where the talar AVN is located and to what degree the bone is necrosing.

[Personwhorocks]

I am no docter, but your feet may be having a reaction. You really should look into getting an MRI. Hope this helps