This 41-year-old female had a sudden onset of bilateral ankle pain in 1993, after playing basketball. She was unable to walk without pain for a week, and sought medical care. She said that radiographs at that time showed "small fractures" and "dead cartilage" in her ankles. Her pain improved gradually over the next six months with conservative care, but then began recurring more and more frequently, interfering with her previously active lifestyle of running and playing tennis. She had no history of ankle trauma.
Over the same time period, she also developed pain, stiffness and swelling of her fingers. This was considered to represent seronegative rheumatoid arthritis. These symptoms have been well-controlled with a low carbohydrate, no sugar diet. She had not taken steroids for this.
The patient was born in Northeast China, and reported that a number of family members and friends from Northeast China have had similar symptoms. She was concerned that she and they have Kashin-Beck disease.
Her ankle pain became progressively worse over the next 12 years, and in 2005 she sought podiatric care. Radiographs revealed osteochondral defects of both talar domes (Fig. 1).
Magnetic resonance imaging (MRI) of both ankles showed osteochondral irregularity and collapse in both talar domes (Fig. 2).
Computed tomography (CT) of both ankles was then performed to assist with surgical planning, and also showed osteochondral irregularity and collapse in both talar domes (Fig. 3).
She was then seen by an orthopedic foot and ankle specialist, who discussed several treatment options, including talar-dome drilling and bone grafting, osteoarticular allograft, total ankle arthroplasty, and ankle arthrodesis. At present, our patient is continuing conservative care, but is considering eventual osteoarticular allografts.