Painful bone marrow edema syndrome of the foot and ankle

Bone marrow edema syndrome (BMES) of the foot and ankle is an uncommon and often undiagnosed disorder that, to our knowledge, has not previously been reported in the orthopaedic literature. The current study reviews a consecutive series of patients who were seen with this musculoskeletal disorder in order to highlight the clinical presentation and diagnostic imaging characteristics specific to this disorder.

A retrospective chart study was performed involving 601 patients who underwent magnetic resonance (MR) imaging of the foot and ankle at our institution from April 2005 to April 2006. We identified 14 patients whose MR imaging demonstrated findings consistent with BMES.

All 14 patients demonstrated characteristic diffuse, irregularly increased signal intensity on T2-weighted MR imaging and variable areas of decreased signal intensity on T1-weighted MR images in an average of three bones within the foot and ankle. Average patient age was 16.4 (range, 10 to 27) years, and no patient reported a history of prior trauma. Eight patients received treatment for an incorrect initial diagnosis with two of those patients undergoing surgical procedures. Twelve patients were successfully treated with supportive nonoperative therapy for an average length of 19.4 months. Four patients had followup MR imaging demonstrating signal changes consistent with their clinical improvement/changes.

BMES of the foot and ankle is a clinical disorder seen in younger patients with a clinical history of prolonged foot and ankle pain of unknown etiology and without prior trauma. MR findings from this series are consistent with previous descriptions in the radiology literature. Furthermore, MR imaging can be utilized to monitor the progression or resolution of this disorder. Proper diagnosis and treatment may prevent further unnecessary diagnostic testing or surgical procedures.