--- title: "Natural hx of avascular necrosis in talus: when to operate. | Sutter Health" description: "Size and location of the avascular region likely determines risk of progression; however, symptoms do not correlate with stage." url: "https://www.sutterhealth.org/research/publications/natural-hx-of-avascular-necrosis-in-talus-when-to-operate-1055312394" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Natural hx of avascular necrosis in talus: when to operate. # Natural history of avascular necrosis in the talus: when to operate. Haskell A. _Foot Ankle Clin. 24(1):35-45. doi: 10.1016/j.fcl.2018.09.002. Epub 2018 Nov 15. Review._ 2019-03-01 ## Abstract Avascular necrosis (AVN) of the talus bone is a progressive and debilitating consequence of trauma or exposure to a variety of risk factors. The Ficat classification describes current understanding of the natural history of AVN, including preclinical, preradiographic, precollapse, postcollapse, and arthritic stages. The size and location of the avascular region likely determines risk of progression; however, symptoms do not correlate with stage. Patients may be minimally symptomatic despite diffuse involvement for long periods. Joint-sparing strategies have shown promise but do not universally prevent progression of the disease. When bone structure fails, joint-sacrificing strategies may be required. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/30685011) ![Andrew Haskell, M.D.](https://dyn.mktgcdn.com/p/e19Z0QwiEJVIawTe_Uey_VlyYexupaSsdn87lO6XoJk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Andrew Haskell, M.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/andrew-haskell-md-1049681101) ## Research topics - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Musculoskeletal Disorders](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Musculoskeletal+Disorders%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Subtalar arthroereisis implant removal in adults: a prospective study of 100 patients.](https://www.sutterhealth.org/research/publications/subtalar-arthroereisis-implant-removal-adults-1055312370) Saxena A, Via AG, Maffulli N, Chiu H. J Foot Ankle Surg. pii: S1067-2516(15)00577-3. doi: 10.1053/j.jfas.2015.12.005. \[Epub ahead of print\] 2016 Feb 10 - Publication ### [Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study.](https://www.sutterhealth.org/research/publications/extracorporeal-shock-wave-tx-plantar-fasciitis-1055312428) Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke IJ, Burgkart R, Gerdesmeyer L. J Bone Joint Surg Am. 97(9):701-8. doi: 10.2106/JBJS.M.01331. 2015 May 06 - Publication ### [Plate fixation with autogenous calcaneal dowel grafting proximal fourth and fifth metatarsal fractures: technique and case series.](https://www.sutterhealth.org/research/publications/plate-fix-autog-calcan-dowel-graft-4-5-metatar-fx-1055312444) Seidenstricker CL, Blahous EG, Bouché RT, Saxena A. J Foot Ankle Surg. pii: S1067-2516(17)30286-7. doi: 10.1053/j.jfas.2017.04.035. \[Epub ahead of print\] 2017 Jun 09 - Publication ### [Lapidus arthrodesis.](https://www.sutterhealth.org/research/publications/lapidus-arthrodesis-1055312388) Hyer CF, Saxena A, Didomenico L. J Foot Ankle Surg. 50(6):784-5; author reply 785. doi: 10.1053/j.jfas.2011.09.014. 2011 Nov 01 - Publication ### [Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.](https://www.sutterhealth.org/research/publications/heel-pain-shockwave-tx-endosc-fasciotomy-1055312338) Saxena A, Fournier M, Gerdesmeyer L, Gollwitzer H. Muscles Ligaments Tendons J. 2(4):312-6. Print 2012 Oct. 2013 Jan 21 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/natural-hx-of-avascular-necrosis-in-talus-when-to-operate-1055312394#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Natural hx of avascular necrosis in talus: when to operate."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/natural-hx-of-avascular-necrosis-in-talus-when-to-operate-1055312394#medicalscholarlyarticle","name":"Natural history of avascular necrosis in the talus: when to operate.","headline":"Natural hx of avascular necrosis in talus: when to operate.","abstract":"Avascular necrosis (AVN) of the talus bone is a progressive and debilitating consequence of trauma or exposure to a variety of risk factors. 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