Avascular Necrosis of the Talus Bone FAQs:

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ESWT to treat avascular necrosis of the talus

What is avascular necrosis (AN)?

Avascular necrosis occurs when normally healthy tissue begins to die due to a lack of blood flow. The word “vascular” refers to blood vessels and blood circulation. The word “necrosis” means cell or tissue death. Avascular necrosis can occur anywhere in the body, but is found most often in bones with a poor blood supply. Specifically, our New York ESWT avascular necrosis patients usually present with AN of the talus bone of the foot. Avascular necrosis is always a serious condition requiring medical attention.

What are the signs and symptoms of avascular necrosis?

At first, there may be no symptoms at all. Many of our avascular necrosis talus Pittsburgh patients only learn they have AN during routine podiatry X-rays. The first symptoms usually felt are a generalized ankle pain, which typically becomes more constant as the disease progresses. Eventually the joint can be affected to the point where the bone collapses—this results in severe pain whenever the joint is used. As an extremely general rule, the time elapsed between the first feelings of pain and bone collapse ranges from 6 months to over a year.

What causes avascular necrosis?

Most patients don’t realize that bone is living tissue with a rich blood supply. Any time that the blood supply to a bone is decreased, avascular necrosis can occur. AN often occurs without an obvious cause, but is often associated with:

  • Long term corticosteroid use (cortisone). Taken either orally or injected, cortisone use is associated with over 35% of all avascular necrosis cases.
  • Sickle cell disease
  • HIV infection
  • Chemotherapy and radiation therapy for cancer
  • Autoimmune diseases such as lupus
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What is the talus bone?

The talus is one of the main bones of the ankle. It connects the leg bone (tibia) to the lower ankle—the dome of the talus is the round surface that the ankle joint pivots on. Most of the cases seen at Beaver Valley Foot Clinic involve the talus, but several of our Cranberry ESWT avascular necrosis patients have the condition in nearby ankle bones. Why does AN frequently occur at the talus? The talus is mostly covered in cartilage. Since cartilage has a poor blood supply, so does the underlying talus bone. Several of our ESWT avascular necrosis Bridgewater patients also present with AN of the cuboid and navicular bones, which unfortunately also generally have poor circulation.

How can ESWT (Extracorporeal Shockwave Therapy) treat avascular necrosis successfully?

Extracorporeal Shockwave Therapy (ESWT) is an excellent treatment for avascular necrosis—it’s unique, in fact. Remember that avascular necrosis is bone death due to lack of blood circulation. To date, Shockwave Therapy is the only treatment recognized to cause an effect called neo-vascularization (the formation of many new capillary arteries in the area). ESWT effectively uses high-intensity ultrasound energy to “jump-start” the healing process. We feel that several of our Butler ESWT avascular necrosis patients have been saved from surgery thanks to Shockwave therapy.

What other bones are frequent sites for avascular necrosis?

As mentioned, AN can occur anywhere in the body, but is most often encountered in bones with an already poor blood supply. These include the hip joint (femur), shoulder (scapula), knee joint, and sometimes even the jaw. AN in the hip joint is often associated with hip replacement surgery.

What are some other common treatments for avascular necrosis?

Typically only three procedures are used to treat AN of the talus. All are invasive, and complete ankle fusion is considered a major surgery. One of our main treatment goals for Pittsburgh talus ESWT patients is avoiding surgery.

Core decompression:

This procedure involves drilling a hole in the talus in an attempt to relieve pressure on the bone and therefore increase the blood supply. Note that this can only be used in the earliest stages of avascular necrosis.


The ankle joint is opened, and the talus is trimmed and repositioned in the hopes of relieving stress on the bone. As with complete fusion, this can be a major orthopedic surgery. This can be used for early to mid-stage AN.

Complete ankle fusion:

Much as it sounds, the irreparably damaged portions of bone are removed and the joint is fused. This effectively removes the joint and alters ankle function forever.

Does surgery work? How often is it successful?

Ankle surgery carries the same risks as any orthopedic surgery, anywhere else in the body. Remember, any surgery basically opens the skin and removes or otherwise alters tissues which are there to perform an important function. Here is a non-exhaustive list of potential problems resulting from surgery (open or arthroscopic).

  • Infection
  • Damage to ligaments and tendons of the ankle
  • Scar tissue formation
  • Nerve and blood vessel damage
  • Surgical failure. If surgery doesn’t work as planned, more surgery may be needed. This is one of the most important reasons to avoid surgery if at all possible. Always look for less invasive options first

Sound Medical Technologies, Inc. owns and operates some of the rare mobile Extracorporeal Shockwave Therapy (“ESWT” ) machines in Pennsylvania and Eastern Ohio. We understand the importance of sensible and effective practice management. Our company is devoted to making ESWT convenient and easy to perform within your office or facility setting. We operate FDA approved Dornier Epos Ultra’s which are ultrasound guided allowing you to see the inflammation within the body and treat it precisely.

Sound Medical Technologies, Inc. offers several ESWT– related services. We provide trained staff and certified technicians to operate the equipment during ESWT procedures. Physician certifications, recommendations and our clinical applications specialist can answer all your questions.

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