We report a 73-year-old female with rheumatoid arthritis, who presented with a 1-year history of ankle pain without trauma. Conventional radiographs showed no bony abnormalities, and bone scintigraphy showed increased uptake in the neck of the left and right talus. Magnetic resonance imaging scans showed insufficiency fractures of the talar neck bilaterally. The patient was treated nonoperatively with weightbearing casts and analgesics. The present case study stresses the need to add insufficiency fractures of the talus to the differential diagnosis of chronic ankle pain when conventional radiographs show no abnormalities. (C) 2013 by the American College of Foot and Ankle Surgeons. All rights reserved.