The authors present two cases of necrosis of the distal tibial epiphysis without evidence of trauma in either of the patients. One patient after a long follow-up showed a Charcot arthropathy. In contrast, the second patient recovered distal epiphysis ad integrum. Close follow-up and ankle protection with an orthosis may be necessary to spare the joint and prevent significant damage. The authors highlight the difficulty in diagnosing these special cases in which pain, a common finding in orthopaedics, is not present.
Level of evidence: IV.