Talus Idiopathic Versus Stress-Injury-Related Osteonecrosis and Its Resolution: A Case Report

A 34-year-old healthy long-distance runner sustained a possible stress injury to the talus. This injury progressed into osteonecrosis (ON) or might have presented idiopathically. This patient had a complete normal metabolic workup. Non-surgical management, including resting, activity modification, and bone stimulators, led to resolution. Serial exams and magnetic resonance imaging demonstrated gradual resolution of the ON. At two years old, she was pain-free and had returned to running. Talus ON is uncommon and even more so in the absence of metabolic disorders or precipitating trauma. This case presents a debatable stress injury, an overuse injury, or even an idiopathic ON. It healed with non-surgical management. Serial, advanced imaging surveillance was implemented. There is a lack of impactful literature regarding the management of early ON and a paucity of strong recommendations to guide non-surgical treatment options in the early stages. This presentation is quite debatable as to whether there was a stress fracture leading to ON or if it was idiopathic ON. Yet, these entities could easily overlap, and physicians and orthopedists should be aware.