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Talonavicular AVN
Submitted by norahs on 30 November, 2009 - 18:26

Hello,

I recently came across your website, and was hoping that someone may be able to help me out.  I have recently received a conflicting dx. regarding both of my ankles.  I am an active 41 year old.  I have somewhat hypermobile joints & have had multiple RT ankle sprains since my early teens when I was running competitively. Also, when I was about 9 yrs of age I was on the back of a snowmobile, and struck my RT ankle (rotated outwards) on a small pine tree as we were traveling past it.  Approx. 10 years ago I started to experience RT foot/ankle pain & was dx. with osteoarthritis.  Due to the pain & my inability to run on uneven surfaces & stopped running regularly.  This past July I saw a rhuematologist & told her that I appeared to have decreased pain & was able to run again on uneven surfaces.  She advised that my joint was more than likely starting to fuse and that it was ok if I was to run (as long as I was not experiencing pain).  Upon this information I began to run and was initially pleased with the results.  I began training with a club, & was increasing distance & improving my times slowly.  Upon beginning to run under a 5 min Km, I started to experience ankle pain again, this time also in my LT ankle.  So I decided , I better get an x-ray & ultrasound of both feet done.  The results were surprising.   The first x-ray report suggested osteonecrosis, worse on the RT than the LT.   Due to the surprising nature of the findings, my family doctor ordered another set of x-rays (since the original x-rays were done at a walk in clinic).   According to my rhumatologist  (who did not look at my films, only the reports) it is unlikely that I have osteonecrosis since it is uncommon, often due to acute injury, & I have no hx or alcoholism /corticosteroid use etc....  
 
So finally, here are my questions....
My second x-ray report found moderate degenerative changes with subchondral cyst formation more prominent on the RT than the LT navicular, & prominent osteophyte formation in the RT talonavicular joint.  It is my understanding that these findings are suggestive of both osteoarthritis & osteonecrosis.  If so, how can a definitive dx be made? I am getting an MRI of the LT.  Should I be getting one of the RT also?  Can osteoarthritis degenerate into osteonecrosis or vice versa?  From the time of onset, how long in general does it take for x-ray images to show the effects of osteonecrosis in the talonavicular joint (this may be a silly question)?  In general, I have degenerative changes in the first MTP joint in both feet, I am slightly hypermobile & have had RT knee dislocations in the past, I have patella femoral syndrome, my finger joints & RT elbow sometimes lock when lifting, and I currently have pain in my rt nuckle when opening jars.  Should I be inquiring or concerned that there may be some other underlying joint/connective tissue disorder involved?
 
Thanks for your time, any information or advice would be appreciated.....
 
 
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