Bone marrow edema of the forefoot after chevron osteotomy--a rare cause of metatarsalgia: a case report.
Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.
Aigner
Nicolas
N
First General Orthopaedic Department, Orthopaedic Hospital Vienna--Speising, Austria. n.aigner@ping.at
Petje
Gerd
G
Steinboeck
Gunther
G
Schneider
Wolfgang
W
Krasny
Christian
C
Landsiedl
Franz
F
D000328:Adult; D001853:Bone Marrow; D004487:Edema / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005534:Foot Diseases / Q000188:drug therapy / Q000209:etiology; D005545:Forefoot, Human; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use; D008682:Metatarsal Bones / Q000601:surgery; D008684:Metatarsus; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D010146:Pain / Q000209:etiology; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D016285:Iloprost