Bone Cyst talus

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As a new member, I have a case for which I would like to hear your opinion regarding proper management of this case which I will present to you.
agement. I've been in private practice for some 19 years and a collea-
gue of mine refers me this 27y/o male with what appears to be an aneurysmal bone cyst on the neck and 2/3 of the body/trochlea of talus on his left foot. It started with an insiduos onset of discomfort along the medial midfoot some 6 months ago, aggravated with ambulation and has progressed to a sharp and throbbing pain, mostly with rest, and gets relief only when wears a Cam Boot. Has tenderness over the talus and TN joint and anterior ankle mortise with lack of dorsiflexion. The MRI diagnosed it as ABC.
I'm considering a 3 phase bone scan, and told my colleague to do first a needle biopsy just to make sure we aren't dealing with a giant cell tumor. My concern is that because ot the extent of the lesion the talus could fracture during surgery, or develops AVN, and to a lesser extent arthrosis incapacitating this young man for life. He works at a Sam,s Club warehouse stocking merchandise all day long.
What are the options??

 

Ist :welcome: to Podiatry Arena.

Not a surg option. I have a patient with somewhat similar problems. Increased walking and walking on uneven ground symptoms are increased.

The patients pain is much more increased on inversion and eversion of the Subtalar joint. Dorsiflexion and Planatarflexion ok if there is no deviation from plane.

Patient has been told surg not an option, I taped her and put her in a rocker shoe symptoms reduced from a 8/10 to a 2-3/10. We are now working around a more permanent treatment approach, using an orthotic and rocker with a ankle brace from long walks. Might be something to consider if Surg is not an option. ie the camwalker helps so maybe something similar but less bulky maybe an option.

Hope it helps something and welcome again to Podiatry Arena. Maybe post up some xrays you may get some more advice re surg. To do this go advanced and scroll down to where you see the manage attachments click on that and follow the instructions.
Goodluck

 

Thanks for your advice!