Abstract
Introduction
Bone Marrow Oedema Syndrome (BMOS) is an unusual and poorly understood condition. It commonly affects the hips and knees and is reported to have a tendency to recur. The foot and ankle are less frequently involved but nevertheless patients can be severely impaired. Only case reports of BMOS of the foot and ankle have been published.
The aim of this study is to evaluate the sites of occurrence, risk factors, efficacy of immobilisation, response to intravenous biphosphonates and local or remote recurrence over the following years.
Methods
A retrospective review of 25 adult patients who have been diagnosed with BMOS have been followed-up for an average of 5.8 years (range: 2–11). Six patients have not been traced.
Results
There were 6 males and 13 females with an average age at presentation of 45.8 and 58.8 years respectively. No statistically significant risk factors could be identified.
The talus was the commonest affected bone (68% of the cases) followed by the intermediate cuneiform and the adjacent second metatarsal (21%) and the cuboid with the adjacent third and fourth metatarsals (15%).
All 19 patients were treated initially with a pneumatic walker: 5 patients had a resolution of their symptom at an average time of 7 weeks. Of the 14 patients who had not improved by approximately 8 weeks, nine received intravenous zolendronate along with the same pneumatic walker and 5 continued with the pneumatic walker alone. The 9 patients who received a single dose of zolendronate experienced significant improvement within an average of 3.6 weeks. Eight patients out of the 19 continue to have pain.
Conclusion
BMOS is often a diagnosis of exclusion. The talus is the most affected bone in the foot and ankle. The majority of patients in this study have improved with a brace and or intravenous zolendronate.
