What is avascular necrosis of the foot?

Avascular necrosis may be the result of the following:

Risk factors include:

The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently. Symptoms may include:

The symptoms of avascular necrosis may look like other medical conditions or bone problems. Always talk with your healthcare provider for a diagnosis.

Along with a complete medical history and physical exam, you may have one or more of the following tests:

Specific treatment for avascular necrosis will be determined by your healthcare provider based on:

The goal of treatment is to improve functionality and stop further damage to the bone or joint. Treatments are needed to keep joints from breaking down, and may include:

Other treatments may include electrical stimulation and combination therapies to promote bone growth.

If you’ve ever broken a bone, the worst issue you have is being in a cast for a few weeks, right? Unfortunately, that’s just not true. A broken bone may lead to several other complications, including decreased blood supply to the affected bone. The result is avascular necrosis, or the death of bone tissue, which is a much bigger issue.

Dr. Jeffrey McAlister is a fellowship trained surgeon who specializes in conditions that affect your feet and ankles, one of which is avascular necrosis. He leads the expert team at Phoenix Foot and Ankle Institute to help you get the specialized treatment you need to regain your mobility.

Avascular necrosis, also known as osteonecrosis, is a condition that causes the death of bone tissue due to lack of a healthy blood supply. Without a constant supply of nutrient-rich blood, your bone isn’t able to rebuild itself, which leads to small breaks and eventually bone death.

In a healthy person, bones are continually rebuilding themselves. When tissue breaks down, your body and bones work around the clock to rebuild healthy tissue. However, if your bones aren’t receiving enough blood, they aren’t able to keep up with the amount of tissue deterioration.

So why do you have decreased blood flow to your bones? There are a few different reasons you might be lacking an adequate blood supply, which include:

Chronic, high dose use of corticosteroids is another cause of avascular necrosis. This is due to the possible increase in lipid levels that can occur with long-term steroid use. Higher lipid levels can impede blood flow to your bones.

Long-term excessive alcohol intake is yet another factor that plays into avascular necrosis. High amounts of alcohol on a regular basis may form fatty deposits in your vessels, impacting normal blood flow.

Knowing your risk for avascular necrosis is only half the battle — understanding the symptoms is a key component to knowing when you need treatment.

Avascular necrosis isn’t a fast-moving disease; in fact, it develops rather slowly. In the beginning stages of this condition, you might not have any symptoms at all. However, as the condition progresses, more signs develop.

In many cases, the first sign of a problem is pain in one of your joints, such as your ankle. The pain is sometimes severe and may come and go.

But as the disease progresses, the pain in your joint often becomes worse and more persistent. It could hurt when you put your weight on the joint, or even when you sit down.

When avascular necrosis gets to the point where the bones are so damaged that your joint collapses, the pain may be debilitating. You also won’t be able to move the joint, not only due to the pain, but due to the damage to the bones as well.

Any sign of pain in your foot or ankle, no matter how severe, is a good indication that it’s time to seek treatment from Dr. McAlister and his team.

To properly diagnose you with avascular necrosis, Dr. McAlister uses imaging such as an MRI or X-ray to see the damage to your joint. Once he determines you’re dealing with avascular necrosis, he uses a number of different treatment strategies to stop more damage from occurring. These treatments include:

If you’re in the early stages of the disease, Dr. McAlister may recommend treatments like rest, physical therapy, or NSAID medications. However, more advanced disease may require more invasive treatment.

This procedure uses healthy bone that’s harvested from another area of your body to give the damaged bone strength and stability.

When other measures don’t work and your joint has collapsed, Dr. McAlister often recommends a joint replacement. In this procedure, he removes damaged areas of your joint and replaces those areas with prosthetics. The prosthetics reshape your joint so you regain range of motion.

Overview. Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years. A broken bone or dislocated joint can stop the blood flow to a section of bone.

Avascular necrosis, also known as Freiberg’s disease or Freiberg’s Infarction or Infraction, is a painful condition that frequently affects young athletes, especially teenaged girls.

The causes of a particular case of avascular necrosis are difficult to pin down, but the condition is often caused by overuse and repetitive stress to the area, or what specialists refer to as “chronic microtrauma.” Runners, soccer players, and dancers tend to be especially vulnerable to Freiberg’s disease.

Additionally, risk factors such as chemotherapy, high dose of steroid use, sickle cell disease are associated with avascular necrosis.

Because the injury develops over a long period of time, it may be tough to detect avascular necrosis in its early stages. If your child is complaining of these symptoms, you may want to have him or her evaluated by a foot and ankle specialist:

Avascular necrosis may look normal on an X-ray in its early stages, so your doctor may order a magnetic resonance imaging (MRI) scan, computerized tomography (CT scan), or bone scan.

Avascular necrosis is easiest to treat when it is caught early. However, due to the progressive nature of the condition, many patients fail to come in for evaluation until symptoms have already become debilitating.

In adults, severe cases of avascular necrosis may require surgery, but treatment is trickier for children and teens because their feet haven’t stopped growing yet. The common surgical techniques used on adults – osteotomy or bone/cartilage transplant – might damage a young patient’s growth plate and stunt growth in the bone.

For this reason, UFAI specialists recommend nonsurgical treatments to limit motion in the joint and relieve symptoms until the growth plate closes, at which time surgery may be recommended. In the meantime, your child’s doctor may recommend physical therapy, rigid-soled shoes and custom-fitted orthotics with the metatarsal head cut out. Anti-inflammatory medications can reduce pain and inflammation.

Your specialist will keep a close watch on your child’s injury and bone development while the area heals. After a few months or years, when the growth plate has closed, one or more surgical procedures may be performed; the correct procedures will be prescribed based on your child’s individual case. These include:

Joint clean-up

This procedure involves the removal of loose bones and spurs in the joint.

Cartilage and/or joint replacement

Healthy tissue from elsewhere in the foot is grafted onto the collapsed metatarsal head.

Implant

A surgical implant is secured onto the metatarsal bone.

Metatarsal head resection

The last resort technique that is not typically performed on younger patients, this procedure involves removal of the bone and replacement of a surgical filler to maintain the length of the toe.