CHRONIC ANKLE PAIN CAUSED BY OSTEOID OSTEOMA OF THE NECK OF THE TALUS

Five patients with osteoid osteomas of the talar neck were treated at the Hospital for Special Surgery between 1981 and 1992. The course of care leading to definitive diagnosis and treatment was reviewed. All f ive of the patients had night pain relieved by aspirin or nonsteroidal anti-inflammatory drugs. One of the five reported associated trauma. The average time from onset of symptoms to correct diagnosis was 2.5 y ears. Juxta-articular osteoid osteoma can cause a small spur that rese mbles a traction spur on the neck of the talus, Anterior ankle impinge ment was the most common misdiagnosis. Initial treatments included art hroscopic spur debridement or synovectomy, casting for fracture, and r epeated nerve blocks for reflex sympathetic dystrophy. The five patien ts were cured by en bloc excision of the lesion. In the diagnosis of o steoid osteoma, a history of relief of pain with aspirin is important. Plain radiographs and a bone scan are useful. Fine cut computed tomog raphy scanning or magnetic resonance imaging are the best studies for making a definitive diagnosis, Localization by computed tomography gui ded needle placement or intraoperative radionuclide scanning are recom mended to find the lesion for excision, Intraoperative radiographs of the excised lesion should be used to confirm complete removal.