Bone Marrow Edema Syndrome in the Foot and Ankle

Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by extremity pain of unknown etiology. Symptoms may include sudden or gradual onset of swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities. The most common sites involved with BMES, in decreasing order of frequency, are the bones about the hip, knee, ankle, and foot. The diagnosis of BMES is confirmed with magnetic resonance imaging to exclude other causes of bone marrow edema. The correct diagnosis in the foot and ankle often is delayed because of the low prevalence and nonspecific signs. This delay may intensify bone pain and impair patient function and quality of life. The goal of BMES treatment is to relieve pain and shorten disease duration. Treatment options are limited and may include symptomatic treatment, pharmacologic treatment, and surgery. Level of Evidence: Level V, expert opinion.

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Response to “Letter Regarding: High Prevalence of Vitamin D Deficiency in Patients With Bone Marrow Edema Syndrome of the Foot and Ankle”

Foot & Ankle International ◽

10.1177/1071100717707989 ◽

2017 ◽

Vol 38 (7) ◽

pp. 768-768

Author(s):

Konstantin Horas

Keyword(s):

Bone Marrow ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Bone Marrow Edema ◽

Foot And Ankle ◽

Bone Marrow Edema Syndrome ◽

High Prevalence ◽

Marrow Edema

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Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost

Foot & Ankle International ◽

10.1177/1071100718778557 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1183-1191 ◽

Cited By ~ 9

Author(s):

Hubert Hörterer ◽

Sebastian Felix Baumbach ◽

Johanne Gregersen ◽

Stefanie Kriegelstein ◽

Oliver Gottschalk ◽

...

Keyword(s):

Bone Marrow ◽

Outcome Measures ◽

Bone Marrow Edema ◽

Pain Treatment ◽

Short Form ◽

Foot And Ankle ◽

Level Of Evidence ◽

Prostacyclin Analog ◽

Marrow Edema

Background: Bone marrow edema (BME) of the foot and ankle is challenging to treat. One approach is intravenous Iloprost treatment, which is a vasoactive prostacyclin analog. The aim of this study was to evaluate the early and intermediate outcome of intravenous Iloprost therapy on BME of the foot and ankle and to analyze the influence of its etiology and Association Research Circulation Osseous (ARCO) stage on the outcome. Methods: This was a retrospective study with prospective follow-up. All patients treated by intravenous Iloprost for BME of the foot and ankle (ARCO I-III) at a single orthopedic reference center were included. Demographics, medical history, and MRIs were assessed prior to treatment (t0). MRIs were used to assess the BMEs’ etiology (idiopathic/ischemic/metabolic, mechanical/degenerative, traumatic) and severity (ARCO). Complications as well as changes in pain, treatment, and MRI were evaluated after 3 months (t1). The following patient-rated outcome measures (PROMs) were assessed prospectively (t2): 12-Item Short Form Health Survey (SF-12), Visual Analog Scale Foot and Ankle (VAS FA), and the Foot Function Index (FFI) (also at t0). The descriptive outcomes and the influence of the etiology and ARCO on the outcome parameters were evaluated. Out of 70 eligible patients, 42 patients (60%; 47 ± 15 years; 30% female) with a mean follow-up of 28 ± 19 months were included. Results: Twelve patients reported minor complications during Iloprost therapy. At t1, pain decreased significantly in 56%, and the amount of BME decreased in 83% of patients. Both parameters correlated moderately (r = −0.463, P = .015). The PROMs at t2 revealed moderate results. The overall FFI improved from 59 ± 21 to 30 ± 22 ( P < .001), the overall VAS FA was 68 ± 20, the SF-12 Physical Component Summary 42 ± 12 and Mental Component Summary 50 ± 9. Subgroup analysis revealed no significant influence of the etiology or ARCO stage on any outcome measure. Conclusion: Iloprost therapy for BME of the foot and ankle resulted in a 60% pain and 80% edema decrease after 3 months. After 2 years, patient-rated outcome measures showed residual impairment. Neither the etiology nor ARCO stage significantly influenced the outcome. Level of Evidence: Level III, comparative study.

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