Steroid-Induced Avascular Necrosis in the Foot and Ankle-Pathophysiology, Surgical, and Nonsurgical Therapies: Case Study and Literature Review.

Foot & ankle specialist Pub Date : 2024-04-01 Epub Date: 2021-06-18 DOI:10.1177/19386400211017375
Shirley Chen, Amber Kavanagh, Caitlin Zarick
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Abstract

Steroid-induced avascular necrosis (AVN) of the lower extremity is a destructive process of the bone found in patients who have been treated with these medications for a variety of medical conditions. There are several proposed etiologies for development of this condition, however much debate still remains for the exact pathophysiology. The main clinical characteristics include edema, arthralgias, and restricted joint range of motion. Diagnostic imaging is a key aspect in the analysis of this pathologic process. When steroid-induced AVN affects multiple bones, this atypical presentation is difficult to treat due to its diffuse nature, therefore surgical options are limited. In these cases, conservative therapy is targeted toward pain relief and preserving joint range of motion. This review aims to provide an overview on the presentation of steroid-induced AVN in the foot and ankle, outline the pathophysiology of the process, and describe a variety of both conservative and surgical treatment options. A case study is provided to showcase a patient presentation of diffuse steroid-induced AVN of the foot and ankle and their course of treatment.Levels of Evidence: Level V: Expert opinion.

类固醇诱发的足踝血管坏死--病理生理学、手术和非手术疗法:病例研究与文献综述。
类固醇诱发的下肢骨血管性坏死(AVN)是一种骨质破坏过程,多见于因各种疾病而接受此类药物治疗的患者。关于这种病症的病因有多种说法,但对其确切的病理生理学仍存在很多争议。主要临床特征包括水肿、关节痛和关节活动范围受限。影像诊断是分析这一病理过程的关键环节。当类固醇诱发的 AVN 影响到多块骨骼时,由于其弥漫性,这种非典型表现很难治疗,因此手术方案有限。在这些病例中,保守治疗的目标是缓解疼痛和保持关节活动范围。本综述旨在概述类固醇诱发的足踝 AVN 的表现,概述其病理生理学过程,并介绍各种保守和手术治疗方案。文中还提供了一个病例研究,展示了一名弥漫性类固醇诱发的足踝部 AVN 患者的表现及其治疗过程:五级:专家意见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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