Victorian Orthopaedic Foot and Ankle Clinic, Epworth Centre, Richmond, Mebourne, Victoria, Australia.
Foot Ankle Int. 2011 May;32(5):S508-12. doi: 10.3113/FAI.2011.0508.
Transient bone marrow edema in the foot and ankle is an uncommon condition that should be distinguished from early avascular necrosis, stress fracture, or bone bruise. The diagnosis is based on the clinical presentation of pain with weightbearing without a history of trauma, combined with typical findings on magnetic resonance imaging. The etiology is not known, but recent case reports have suggested a possible link to systemic osteoporosis. This study examined the relationship between transient bone marrow edema of the foot and ankle and low systemic bone mineral density.
Over a period of 2 years, ten patients (eight women and two men) who were referred to our foot and ankle clinic were diagnosed as having transient bone marrow edema. Their mean age was 59 years. All underwent dual energy X-ray absorptiometry (DEXA) scan and were tested for serum vitamin D levels. The patients were treated with either a controlled ankle motion (CAM) walker or a stiff-soled postoperative shoe and all recovered in 5 to 10 months.
Four patients were found to have osteoporosis and five had osteopenia. Only one patient had normal bone density. Serum vitamin D levels were low in nine patients, and normal in one.
Our study found a strong association with transient bone marrow edema in the foot and ankle and low systemic bone mineral density, which appears to be due to a vitamin D deficiency. We recommend that, when TBME is diagnosed, patients should be referred for assessment and treatment of their bone mineral density.
足部和踝关节一过性骨髓水肿是一种不常见的疾病，需要与早期缺血性坏死、应力性骨折或骨挫伤相鉴别。诊断基于疼痛的临床表现，即负重时疼痛，无创伤史，并结合磁共振成像的典型表现。病因尚不清楚，但最近的病例报告表明，其可能与全身性骨质疏松症有关。本研究探讨了足部和踝关节一过性骨髓水肿与低系统性骨矿物质密度之间的关系。
在 2 年的时间里，我们足部和踝关节诊所共收治了 10 例（8 名女性和 2 名男性）被诊断为一过性骨髓水肿的患者。他们的平均年龄为 59 岁。所有患者均接受双能 X 线吸收法（DEXA）扫描和血清维生素 D 水平检测。患者接受控制踝关节运动（CAM）步行器或硬底术后鞋治疗，所有患者均在 5 至 10 个月内康复。
4 例患者被诊断为骨质疏松症，5 例患者为骨量减少。只有 1 例患者骨密度正常。9 例患者血清维生素 D 水平低，1 例正常。
我们的研究发现足部和踝关节一过性骨髓水肿与低系统性骨矿物质密度之间存在很强的相关性，这似乎是由于维生素 D 缺乏所致。我们建议，当诊断为 TBME 时，应将患者转介进行骨矿物质密度评估和治疗。
