Subchondroplasty for Treatment of Bone Marrow Edema in the Foot and Ankle

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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High Prevalence of Vitamin D Deficiency in Patients With Bone Marrow Edema Syndrome of the Foot and Ankle

Foot & Ankle International ◽

10.1177/1071100717697427 ◽

2017 ◽

Vol 38 (7) ◽

pp. 760-766 ◽

Cited By ~ 21

Author(s):

Konstantin Horas ◽

Lukas Fraissler ◽

Gerrit Maier ◽

Franz Jakob ◽

Lothar Seefried ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Vitamin D ◽

Bone Marrow Edema ◽

Vitamin D Status ◽

Foot And Ankle ◽

Bone Microenvironment ◽

Resonance Imaging ◽

Vitamin D Levels ◽

Marrow Edema

Background: Bone marrow edema syndrome (BMOS) is a phenomenon primarily affecting the lower extremity. It is characterized by a sudden onset of pain and an ill-defined osseous hyperintense signal in magnetic resonance imaging. The main cause of BMOS is still largely unknown. Its pathophysiology is presumably multifactorial and it has recently been demonstrated that it usually involves an increase in bone turnover and alterations within the bone microenvironment. Vitamin D plays a pivotal role in maintaining a healthy and well-balanced bone microenvironment. However, to date only limited information has been reported on vitamin D status in patients with BMOS. Moreover, it is still uncertain whether hypovitaminosis D is associated with the etiology and course of the disease. For this reason, the aim of this study was to determine serum vitamin D levels (25(OH)D) of patients diagnosed with BMOS of the foot and ankle. Methods: Patients were identified and laboratory results collected by retrospective review of the medical records between year 2011 and 2015. Diagnosis was based on clinical examination, the existence of prolonged foot pain, the presence of abnormal bone marrow signal intensity in T1- and T2-weighted magnetic resonance imaging, and the patient’s medical history. All patients who demonstrated other concomitant diagnoses were excluded from the study. Results: Overall, 31 patients were affected by BMOS with a mean age of 44.4 (range, 18-76) years. Notably, 84% of patients (26/31) had low vitamin D levels with a mean 25(OH)D level of 19.03 ng/mL. Specifically, 61% of patients (19/31) were vitamin D deficient, 23% (7/31) vitamin D insufficient, and only 5 patients (16%) had sufficient vitamin D levels. Statistical analysis showed no significant difference comparing vitamin D levels with patient age, sex, and time of diagnosis. Moreover, there was no correlation between vitamin D status and the number of bony foci or location of BMOS. Conclusion: We found a widespread rate of vitamin D deficiency in patients presenting with BMOS of the foot and ankle. Comparing these data to the vitamin D status of the general population in Germany and to patients living in comparable latitudes, this raises the possibility that BMOS might be associated with low vitamin D status. Level of Evidence: Level IV, retrospective case series.

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Relationship Between the Size of Bone Marrow Edema of the Talus and Ankle Pain

Journal of the American Podiatric Medical Association ◽

10.7547/1010430 ◽

2011 ◽

Vol 101 (5) ◽

pp. 430-436 ◽

Cited By ~ 6

Author(s):

Murat Tonbul ◽

Aliye Yildirim Guzelant ◽

Aysun Gonen ◽

Emre Baca ◽

Mehmet U. Ozbaydar

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Bone Marrow Edema ◽

Rating Scale ◽

Foot And Ankle ◽

Resonance Imaging ◽

Mri Scans ◽

American Orthopaedic ◽

Marrow Edema

Background: We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient’s pain during activity and pain during rest in bone marrow edema. Methods: A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients’ ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined. Results: The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest. Conclusions: Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again. (J Am Podiatr Med Assoc 101(5): 430–436, 2011)

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

Foot & Ankle International ◽

10.1177/1071100717706920 ◽

2017 ◽

Vol 38 (7) ◽

pp. 767-767

Author(s):

Andrzej Boszczyk

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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Asymptomatic Foot and Ankle Abnormalities in Elite Professional Soccer Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120979994 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097999

Author(s):

Eduard Bezuglov ◽

Vladimir Khaitin ◽

Artemii Lazarev ◽

Alesia Brodskaia ◽

Anastasiya Lyubushkina ◽

...

Keyword(s):

Bone Marrow ◽

Subchondral Bone ◽

Bone Marrow Edema ◽

Soccer Players ◽

Osteochondral Lesions ◽

Foot And Ankle ◽

Cartilage Lesions ◽

Professional Soccer ◽

Mri Scans ◽

Marrow Edema

Background: Professional soccer players are often evaluated with asymptomatic lesions of the ankle and foot, and such abnormalities may eventually become clinically relevant. Purpose: To ascertain the prevalence of foot and ankle abnormalities in elite professional adult soccer players. Study Design: Case series; Level of evidence, 4. Methods: Professional adult male elite soccer players (n = 37) underwent magnetic resonance imaging (MRI) scans of both their feet and ankles. All competed for their respective national junior or adult soccer teams. MRI scans were performed with 1.5-T scanners and analyzed independently by 2 experienced radiologists. Results: The MRI scans of 86.5% of the players showed degenerative joint disease (DJD) in at least 1 of the joints of the foot and ankle. Articular cartilage lesions in the joints of the foot and ankle were evident in 42% of the scans. Of all lesions, 17% were grade 3 or 4 (Noyes and Stabler classification) cartilage lesions and accompanied by subchondral bone marrow edema. The greater the age, weight, and height of the players, the greater was the odds ratio of DJD of the ankle joint. Synovitis in at least 1 of the joints of the foot was detected in 64% of the MRI scans. Leg dominance significantly correlated with bone marrow edema of the talus. Conclusion: Elite professional soccer players are often evaluated with a high prevalence of asymptomatic osteochondral lesions with subchondral bone marrow edema in the foot and ankle. These osteochondral lesions may remain asymptomatic or, with the continuing high-intensity stresses that modern professional soccer demands of its athletes, may evolve and cause foot and ankle pain. It is unclear whether and which interventions can be implemented to prevent the occurrence of these abnormalities in the first place.

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Bone Marrow Edema Syndrome in the Foot and Ankle

Foot & Ankle International ◽

10.1177/1071100716664783 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1364-1373 ◽

Cited By ~ 20

Author(s):

Seyed Alireza Mirghasemi ◽

Elly Trepman ◽

Mohammad Saleh Sadeghi ◽

Narges Rahimi ◽

Shervin Rashidinia

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Treatment Options ◽

Correct Diagnosis ◽

Symptomatic Treatment ◽

Unknown Etiology ◽

Foot And Ankle ◽

Level Of Evidence ◽

Bone Marrow Edema Syndrome ◽

Marrow Edema

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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