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MRI showed trace of ankle joint more subtalar joint fluid and synovitis. Do I need surgery?

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Orthopaedic Surgeon
Practicing since : 1994
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My MRI states
Trace of ankle joint more subtalar joint fluid and synovitis. Small osteochondral defect of the medial talo shoulder with some end on osteophytic spurring present over approx 4mm on coronal plane mad 1cm on safittal plane. Some cartridge irregularity at this site. Os trigonometry elongated posterior process of talus. Subtalar joint irregular cortical margins And diffuse altered marrow signal intensity consistent with subtalar joint presumed post traumatic osteoarthritis. No overt bony ankylosis to suggest tarsal coalition. Sometimes fibrous coalition may be associated with these marked subtalar osteoarthritis features.

Focal grade intrados serous ganglion navicular and altered bone marrow signal intensity at the base of the metatarsals 1st,2nd,3rd and also irregularly of the cuneiforms. Intermediate cuneiform dismally lateral cuneiform proximally

What does this mean and if I need surgery what would be done please help. I have just had 3 lots of surgery on my right foot in 2 years and the thought of more is very distressing. If I dearly surgery will I do more harm to my left foot
I have a auto immune disease
Posted Mon, 26 Nov 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 1 hour later
Thanks for posting your query.
The findings of your MRI are suggestive of inflammatory changes in the subtalar joint.
The treatment is done according to the severity of symptoms. Medicines are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life in case os severe persistent pain.
The main treatment of such problem is pain killers and muscle relaxants. Muscle relaxants can help with your symptoms if used in appropriate dosage in combination with a potent analgesic. You can get these prescribed from your orthopedician.
Local analgesic gels and hot fomentation may provide a short term relief. You can use analgesic gels like Volini gel. Exercise is not advisable in the times of acute pain.
Using a brace of appropriate size might be helpful in providing support.
Physiotherapy also plays a major role in treating such conditions. Local steroid injections have been used if oral pain killers are not very effective and surgical treatment is not considered. Discuss with your orthopedician and an appropriate treatment can be planned depending on the response to medical drugs.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: MRI showed trace of ankle joint more subtalar joint fluid and synovitis. Do I need surgery? 7 hours later
Is there any degeneration in the mid foot area? How severe is this in the sub XXXXXXX area?
If there is problem in the mid foot area and need surgery as my pain is extreme can both areas be operated on at once to avoid another operation.
I have UCTDfor some years now and are on a cocktail array of drugs such as cortisone , plaque nil 200 daily, methotrexate 20 mg weekely, sulphate salizine daily as well as having just completed 12 months on enbrel 50 mcg weekly. This does not seem to be preventing further destruction on my joints in the foot ankle. My rheumy is going to start me on Orencia weekly s/c injections. Am I going to end up crippled if we can't arrest this joint destruction

May 2012 had my 1st operation on my right mid foot and was a sicess
Answered by Dr. Praveen Tayal 4 hours later
Thanks for writing again.
There is mild degeneration in the mid foot area too.
The subtalar area is more severely affected.
In extreme cases, surgery may be required and both the areas can be taken care of in one sitting. It depends on the physical evaluation of your orthopedician.
The most effective way of preventing the further progression of the disease is hot fomentation and a regular physiotherapy. You will have to continue it even after the surgery.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by
Follow-up: MRI showed trace of ankle joint more subtalar joint fluid and synovitis. Do I need surgery? 29 hours later
Will I be doing any more damage to this left foot if I put the surgery off for some time. The reason I am asking is that I have had 3 foot surgeries since may 2010 for a mid foot fusion which was successful then in sept 2011 a sub XXXXXXX fusion rt foot but not successful as it failed to completely fuse so lat July 2012 I had it redone this time with bone graft from hip as well as artifical bone powder and so far it seems to be healing.
I want to delay having more surgery from a psychological point of view as the thought of 6 weeks non weight bearing is too much.
What would be your suggestions- the pain in this left foot is very severe and disabling at times
I was using for embrel for a year and it does not seem to have prevented further joint destruction
Answered by Dr. Praveen Tayal 4 hours later
Since the pain is severe and is progressively increasing, surgery might be necessary in your case. Delaying the surgery may cause an increase in the rate of degeneration.
If you want to avoid the surgery for a few weeks then go for regular physiotherapy and hot fomentation in the area.
A clinical assessment is necessary for a better evaluation.
Above answer was peer-reviewed by
Follow-up: MRI showed trace of ankle joint more subtalar joint fluid and synovitis. Do I need surgery? 15 hours later
what is the extent of damage to the Tamar bone and of so what can be done to fix it up
Answered by Dr. Praveen Tayal 4 hours later
The damage of the joint space and the articular surfaces is assessed by comparing it to the other side in correlation with clinical symptoms. There is no defined upper limit of the damage. It is the pain which is more important in determining the time for surgery.
Regular physiotherapy is the best way to avoid further progression of the problem.
Above answer was peer-reviewed by
Follow-up: MRI showed trace of ankle joint more subtalar joint fluid and synovitis. Do I need surgery? 47 hours later
I just spoke with my rheumatologist who read the report and she felt it was not a serious enough problem at present to act on this. In your opinion how serious is the degeneration and if Idelayvthe surgery because psycholigally the thought of another bout of surgery (it will make it the 4th lost of surgery in 26 months) is a lot to process
Answered by Dr. Praveen Tayal 56 minutes later
As per your reports, the surgery is not immediately needed if the pain is adequately controlled with medicines. You need a regular treatment and hot fomentation with physiotherapy. In such cases, sometimes we can delay the surgery by as much as 2-3 years with regular treatment. Steroid injections locally can be considered to decrease the inflammation around the joint surface.
The further degeneration can be prevented to a large extent with the help of a proficient physiotherapist.
I wish you the very best in whatever you do.
Warm regards.
Above answer was peer-reviewed by
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