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Osteonecrosis of Ankle and Foot
Brady K. Huang, MD; Cheryl A. Petersilge, MD, MBA; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Imaging

    • Clinical Issues

      TERMINOLOGY

      • Synonyms

        • Osteonecrosis (ON), avascular necrosis (AVN), aseptic necrosis, some more accurately classified as osteochondroses of developing ossification centers
      • Definitions

        • Hawkins sign: subchondral ↑ lucency in talar dome
        • Köhler disease: childhood-onset navicular osteochondrosis
        • Mueller-Weiss disease: adult-onset navicular ON
        • Freiberg infraction: insult involving metatarsal head
        • Sesamoiditis: poorly defined term; may refer to any painful condition of sesamoid bones, including ON

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Nuclear Medicine Findings

                PATHOLOGY

                • General Features

                  • Staging, Grading, & Classification

                    • Gross Pathologic & Surgical Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Baldassarre RL et al: Periosteal stripping in high ankle sprains: an association with osteonecrosis. Clin Imaging. 67:237-45, 2020
                              2. Martin Oliva X et al: Aseptic (avascular) bone necrosis in the foot and ankle. EFORT Open Rev. 5(10):684-90, 2020
                              3. Samim M et al: Imaging of Mueller-Weiss syndrome: a review of clinical presentations and imaging spectrum. AJR Am J Roentgenol. 207(2):W8-18, 2016
                              4. Bartolotta RJ et al: Mueller-Weiss syndrome: imaging and implications. Clin Imaging. 38(6):895-8, 2014
                              5. Blanke F et al: Osteonecrosis of distal tibia in open dislocation fractures of the ankle. Injury. 45(10):1659-63, 2014
                              6. Issa K et al: Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg Am. 96(9):e73, 2014
                              7. Talusan PG et al: Freiberg's infraction: diagnosis and treatment. Foot Ankle Spec. 7(1):52-6, 2014
                              8. Buchan CA et al: Imaging of postoperative avascular necrosis of the ankle and foot. Semin Musculoskelet Radiol. 16(3):192-204, 2012
                              9. Tosun B et al: Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome. J Foot Ankle Surg. 50(2):221-4, 2011
                              10. Carmont MR et al: Current concepts review: Freiberg's disease. Foot Ankle Int. 30(2):167-76, 2009
                              11. Torriani M et al: MRI of metatarsal head subchondral fractures in patients with forefoot pain. AJR Am J Roentgenol. 190(3):570-5, 2008
                              12. Khoury J et al: Kohler disease: diagnoses and assessment by bone scintigraphy. Clin Nucl Med. 32(3):179-81, 2007
                              13. Pearce DH et al: Avascular necrosis of the talus: a pictorial essay. Radiographics. 25(2):399-410, 2005
                              14. Tehranzadeh J et al: Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 181(6):1559-63, 2003
                              15. Toussirot E et al: Avascular necrosis of the hallucal sesamoids update with reference to two case-reports. Joint Bone Spine. 70(4):307-9, 2003
                              16. Taylor JA et al: Painful conditions affecting the first metatarsal sesamoid bones. Radiographics. 13(4):817-30, 1993
                              17. Haller J et al: Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings. AJR Am J Roentgenol. 151(2):355-8, 1988
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Imaging

                                • Clinical Issues

                                  TERMINOLOGY

                                  • Synonyms

                                    • Osteonecrosis (ON), avascular necrosis (AVN), aseptic necrosis, some more accurately classified as osteochondroses of developing ossification centers
                                  • Definitions

                                    • Hawkins sign: subchondral ↑ lucency in talar dome
                                    • Köhler disease: childhood-onset navicular osteochondrosis
                                    • Mueller-Weiss disease: adult-onset navicular ON
                                    • Freiberg infraction: insult involving metatarsal head
                                    • Sesamoiditis: poorly defined term; may refer to any painful condition of sesamoid bones, including ON

                                  IMAGING

                                  • General Features

                                    • Radiographic Findings

                                      • CT Findings

                                        • MR Findings

                                          • Nuclear Medicine Findings

                                            PATHOLOGY

                                            • General Features

                                              • Staging, Grading, & Classification

                                                • Gross Pathologic & Surgical Features

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Baldassarre RL et al: Periosteal stripping in high ankle sprains: an association with osteonecrosis. Clin Imaging. 67:237-45, 2020
                                                          2. Martin Oliva X et al: Aseptic (avascular) bone necrosis in the foot and ankle. EFORT Open Rev. 5(10):684-90, 2020
                                                          3. Samim M et al: Imaging of Mueller-Weiss syndrome: a review of clinical presentations and imaging spectrum. AJR Am J Roentgenol. 207(2):W8-18, 2016
                                                          4. Bartolotta RJ et al: Mueller-Weiss syndrome: imaging and implications. Clin Imaging. 38(6):895-8, 2014
                                                          5. Blanke F et al: Osteonecrosis of distal tibia in open dislocation fractures of the ankle. Injury. 45(10):1659-63, 2014
                                                          6. Issa K et al: Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg Am. 96(9):e73, 2014
                                                          7. Talusan PG et al: Freiberg's infraction: diagnosis and treatment. Foot Ankle Spec. 7(1):52-6, 2014
                                                          8. Buchan CA et al: Imaging of postoperative avascular necrosis of the ankle and foot. Semin Musculoskelet Radiol. 16(3):192-204, 2012
                                                          9. Tosun B et al: Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome. J Foot Ankle Surg. 50(2):221-4, 2011
                                                          10. Carmont MR et al: Current concepts review: Freiberg's disease. Foot Ankle Int. 30(2):167-76, 2009
                                                          11. Torriani M et al: MRI of metatarsal head subchondral fractures in patients with forefoot pain. AJR Am J Roentgenol. 190(3):570-5, 2008
                                                          12. Khoury J et al: Kohler disease: diagnoses and assessment by bone scintigraphy. Clin Nucl Med. 32(3):179-81, 2007
                                                          13. Pearce DH et al: Avascular necrosis of the talus: a pictorial essay. Radiographics. 25(2):399-410, 2005
                                                          14. Tehranzadeh J et al: Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 181(6):1559-63, 2003
                                                          15. Toussirot E et al: Avascular necrosis of the hallucal sesamoids update with reference to two case-reports. Joint Bone Spine. 70(4):307-9, 2003
                                                          16. Taylor JA et al: Painful conditions affecting the first metatarsal sesamoid bones. Radiographics. 13(4):817-30, 1993
                                                          17. Haller J et al: Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings. AJR Am J Roentgenol. 151(2):355-8, 1988