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Osteonecrosis in the Foot

Dr. DiGiovanni is Associate Professor and Chief, Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, Rhode Island Hospital, Brown Medical School, Providence, RI. Dr. Patel is Resident, Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University. Dr. Calfee is Fellow, Department of Orthopaedic Surgery, Rhode Island Hospital, Brown University. Dr. Nickisch is Assistant Professor, Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. DiGiovanni, Dr. Patel, Dr. Calfee, and Dr. Nickisch.

Reprint requests: Dr. DiGiovanni, Department of Orthopaedic Surgery, Rhode Island Hospital, Brown Medical School, 593 Eddy Street, Providence, RI 02903.

Osteonecrosis, also referred to as avascular necrosis, refers to the death of cells within bone caused by a lack of circulation. It has been documented in bones throughout the body. In the foot, osteonecrosis is most commonly seen in the talus, the first and second metatarsals, and the navicular. Although uncommon, osteonecrosis has been documented in almost every bone of the foot and therefore should be considered in the differential diagnosis when evaluating both adult and pediatric foot pain. Osteonecrosis is associated with many foot problems, including fractures of the talar neck and navicular as well as Kohler's disease and Freiberg's disease. Orthopaedists who manage foot disorders will at some point likely be faced with the challenges associated with patients with osteonecrosis of the foot. Because this disease can masquerade as many other pathologies, physicians should be aware of the etiology, presentation, and treatment options for osteonecrosis in the foot.