Question
I have had a serious car accident last summer and am recovering from multiple fractures on my feet.  My question is related to my R foot.  I have a non-healing calcaneous fracture and now have been told that my talas bone has avn.  I will be getting a TPB brace and will be essentially NWB again, indefinately.  Already have had my R ankle fused, and a bone graft to my calcaneous.  Is there any further options avaliable, or am I facing a BK amputation?  Pain is quite severe.  On a duragesic pain patch. Please advise.  I would be very grateful for any advice.  I am 40 Y.o.  
Thanks, Sue

Answer
Hi Sue

I have to be honest and tell you that my expertise is not in the bones of the ankle.  I can talk intelligently about hip bones and replacements, but not about the ankle.

I do, however, know about AVN which you inferred that you are suffering from.  I do know that the injuries you sustained is in the area of the ankle and heel, and I do know that they have ankle replacements which, if your doctor decides is something you can benefit from, might be a good option.

I do not know where you live, but my suggestion before proceeding any further would be to get to see if your insurance covers out of network doctors.  With the injuries you have sustained you need to be seen by a very knowledgeable orthopedist.  The Hospital of Special Surgery or the Hospital of Bone and Joint Diseases in New York City are the best that I know of.  Also if you are in the area of Northern Virginia, the Anderson Clinic at Mount Vernon has the cutting edge diagnostic tools and staff.

If you are not near these hospitals, you need to get to the largest hospital in your area that is a "teaching hospital".  That is, a hospital directly connected with a medical school.  Look for that information on the internet.

Duragesic patches are very strong pain medications and have to try and avoid constipation from them. They are also highly addictive, so you really need to get to the crux of your problem with a doctor who has had a lot of experience with ankle problems.

I wish you the best of luck.

Sharon Davis