A Rare Presentation of Transient Osteoporosis of the Talus: Case Report

Transient osteoporosis (TO) is a rare diagnosis usually observed in the hip and it is extremely rare to identify TO in the talar bone. Bariatric surgery and other weight loss treatments for obesity are linked to decreased bone mineral density and a possible risk factor of TO.

A 42-year-old man, known case of gastric sleeve surgery 3 years back otherwise medically free, presented with unusual symptoms in an outpatient setting with on and off pain for the past 2 weeks that increased with walking and reduced by rest. Magnetic resonance imaging (MRI) of the left ankle 2-month post-pain showed diffused edema of the talus body and neck. He was diagnosed with TO and started the recommendation of nutritional supplementation therapy of calcium and Vitamin D. It was also advised to start protected weight bearing (pain free activity), and to wear air cast boot for at least 4 weeks. Only paracetamol was prescribed as pain relief medication and light activities for 6-8 weeks. At follow-up, 3 months after the MRI of the left ankle showed marked improvement and decrease of talar edema. At the final follow up, 9 months after the diagnosis, the patient presented a successful follow-up with no trace of edema nor pain.

TO is a rare disease and recognizing TO in the talus is extraordinary. The supplementation, protected weight bearing, and wearing air cast boot were effective in the management of our case, correlation between bariatric surgery and TO should be investigated.