Left leg and ankle pain

Last November (2010) my 11 yr old son has a 300lb wooden book shelf fall on his leg while at school. He has complained of pain at he outside ankle joint to about 4 in above the ankle, since the cast came off in December of 2010, the orthopedic finally ordered an MRI of the ankle. MRI showed a lot of bone marrow edema and a talus fracture. What are our options for this type of fracture. My son had significant soft tissue injuries from just above the left knee down to the ankle. I have made many calls to the orthopedic nurse, I was always told this is common and will eventually get better and to just give it time. Well it has been 8 mos and there is still pain... I was told surgery and/or another cast is an option. I am at a loss here, my son is very active and athletic but has had to take it easy because of the pain.

ANSWER

Hi,
The problem with answering your question is that I do not know what type of talar fracture your son suffered. Talar dome fractures involve the part of the talus that creates the ankle joint and so there can be issues with the ability of the ankle to function properly if the fracture has occurred within the dome. If the fracture is within the body of the talus and it was a simple fracture then it should have healed by now, in an otherwise healthy child.
It has now been nine months since the injury. I am not so sure that casting alone will remedy the problem regardless of the type of fracture. At the very least he might be a candidate for a bone stimulator along with casting in an effort to heal a simple fracture.
If it turns out that he has a talar dome fracture and a piece of it is displaced then surgical intervention might be his only option. This can be in the form of arthroscopic or open surgery depending on the severity and actual location of the talar fracture.
I would think that perhaps a second opinion from a local foot specialist in your area, one who can review the xrays and MRI would probably be a good idea.

Marc Mitnick DPM
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