Q: I am a 65-year-old woman. I have done a lot of sports in my life, and I am now having trouble with my right heel and foot.
I have had several courses of steroid treatment with prednisone. I am getting pain on the bottom of my heel and on the outer edge of the back of my foot. It hurts to walk. The doctor said it looks like avascular necrosis of the ankle bone. What is this, and is there any cure?
A: When the blood supply to any bone, including the ankle, is cut off for any length of time, the bone cells and tissue can die.
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This causes the bone to collapse and cave in. If this process occurs near the surface of the bone near a joint, it can cause a destruction of the surface of the joint, which can mimic arthritis.
You have mentioned two of the possible causes of this disease. One is trauma from a sports or other type of injury.
When a joint is injured from a fracture or dislocation, the blood vessels can be damaged.
In more than 20 percent of people who dislocate their hip joints, avascular necrosis can be the result.
Another common cause is the use of certain medications, especially the steroids such as prednisone. I have often cautioned against the use of this drug unless there is no other possible treatment available.
The side effects are horrendous. Excessive alcohol consumption can also be a factor, as this can cause fatty deposits in the walls of the blood vessels, thus decreasing the blood supply to the bone.
Avascular necrosis can often be diagnosed with a simple X-ray, but sometimes a CT scan, a bone scan or an MRI is needed to discover the problem area.
What treatments are available? In some cases, if the disease is caught early enough, all that is required is for you to keep off your foot long enough for the bone tissue to repair itself.
Unfortunately, most sufferers will eventually need surgery. One type is known as core decompression. The orthopedic surgeon removes the inner layer of bone to allow more blood vessels to grow through the empty space.
This has to be done before the stage when the joint collapses. A bone graft is sometimes used to supplement this procedure.
In late stages of the disease, the only other option is total joint replacement or arthroplasty.
However, it sounds as though you may have caught it in time if you have pain only when you put weight on the foot.
