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

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 Are The Symptoms Of Avascular Necrosis?

At the early stages of avascular necrosis you may not notice any symptoms at all, but as the times passes the condition will start getting worse and you will start noticing symptoms like pain in your joints.

When your condition is bad you may not be able to use your joint and may face unbearable pain while moving your joint. If this happens then it may be a sign of Avascular necrosis, visit your doctor if you experience such kind of symptoms.

Can avascular necrosis of the talus lead to arthritis?

Yes, avascular necrosis of the talus can potentially lead to arthritis. Avascular necrosis, also known as osteonecrosis, is the death of bone tissue due to a lack of blood supply. When the talus bone in the foot undergoes avascular necrosis, it can disrupt the normal functioning and integrity of the joint.

Avascular necrosis of the talus can cause the bone to collapse or become fragmented, leading to joint damage. As a result, the articular cartilage, which provides cushioning and allows smooth joint movement, can become damaged or eroded. The loss of healthy bone and cartilage can ultimately lead to the development of arthritis in the affected joint.

Arthritis refers to the inflammation and deterioration of a joint, leading to pain, stiffness, swelling, and restricted mobility. In the context of avascular necrosis of the talus, the arthritis that develops is typically termed post-traumatic arthritis, as it arises following an injury or damage to the talus bone.

The progression to arthritis can vary among individuals and may depend on factors such as the extent of avascular necrosis, the effectiveness of treatment, and the presence of additional risk factors. Early detection, appropriate treatment, and management strategies can help minimize the risk and impact of arthritis associated with avascular necrosis of the talus.

How long does the recovery process typically take for avascular necrosis of the talus?

The recovery process for avascular necrosis of the talus can vary depending on the severity of the condition, the treatment approach, and individual factors. It typically takes several months for initial healing, but complete recovery can take much longer. Non-surgical treatments may require a period of immobilization and restricted weight-bearing, followed by a gradual return to activity. Surgical interventions, such as core decompression or joint replacement, may involve a longer recovery period, often spanning several months to a year, including rehabilitation and physical therapy.

Who Are At A Risk Of Avascular Necrosis?

This condition is common most of the time and anyone can get it but there are some risk factors that make it more likely to happen to you, here are some of those factors:

  1. Aging

Being over 50 highly increased the chances of Avascular necrosis as after 50 your bones and joints start getting weak. They can’t work the way they used to and can be easily damaged.

  • Injuries

Direct injuries on your joints or bones can be a really dangerous situation and this kind of situation are idea for Avascular necrosis to occur.

This is even more dangerous if your injury doesn’t receive a proper treatment, since this may worsen your situation and increase risks of Avascular necrosis in future.

  • Some Type Of Treatments

Every kind of treatment has some side effects and these side effects can make you a patient of Avascular necrosis.

For example, the radiation therapies used for cancer can weaken your bones are put you at a risk of fractures or any other bone problems.

  • Alcohol Or Smoking

Alcohol is already bad for your health especially because it doesn’t let’s your blood flow properly, if you consume alcohol on daily basis then you are preventing your bones from getting enough blood.

The same goes for smoking!

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

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