Avascular Necrosis of the Tibial Plafond and Talus After Intra-articular Corticosteroid Injection: A Case Report

TL;DR

A 61-year-old woman developed avascular necrosis in her ankle after corticosteroid injections, highlighting a rare but serious complication.

Contribution

This case report highlights the rare but significant risk of avascular necrosis following intra-articular corticosteroid injections.

Findings

Avascular necrosis of the talus and tibial plafond occurred two months after corticosteroid injections.

Arthroscopic debridement improved symptoms, but mild pain and limitations persisted.

The case underscores the need for advanced imaging in unexplained ankle pain following steroid injections.

Abstract

A 61-year-old female presented 13 months after a fall down three stairs on September 14, 2021. Her chief complaint consisted of anterior and lateral ankle pain. Initial imaging studies, including an MRI in February 2022, were unremarkable. She underwent conservative treatment for soft tissue impingement syndrome under the care of a podiatric surgeon. This included two corticosteroid injections. After the second injection, she reported an increase in pain. She did not sustain any new trauma. An MRI that was taken in April of 2022, two months after her second steroid injection, demonstrated avascular necrosis (AVN) of the talus and tibial plafond. In an effort to decrease her symptoms associated with impingement syndrome, arthroscopic debridement focusing on the removal of scar tissue and synovitis was performed. It was decided to observe the areas of avascular bone, secondary to inherent risks in the surgical management of AVN. In addition, it was unknown how much of the pain was coming from the avascular process versus the impingement syndrome. Her symptoms have improved, but she continues to have mild ankle pain and limitations. Although a rare complication, this case demonstrates the risk of developing ankle AVN after receiving a corticosteroid injection. When confronted with ongoing ankle pain, advanced imaging may be warranted to rule out AVN.

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