Midfoot and hindfoot bone marrow edema identified by magnetic resonance imaging in feet of subjects with diabetes and neuropathic ulceration is common but of unknown clinical significance.
OBJECTIVE
We conducted a retrospective cohort study assessing the prevalence and clinical and radiological outcome of remote areas of bone marrow edema on magnetic resonance imaging (MRI) in the feet of subjects with diabetes and neuropathic foot ulceration.


METHODS
MRIs performed over 6 years looking for osteomyelitis associated with neuropathic lesions were assessed for remote areas of signal change.


RESULTS
Seventy MRI studies were assessed. Remote areas of signal change were present in 21 (30%) subjects, involved midfoot or hindfoot in 20 subjects, were associated with younger age and renal replacement therapy, and did not predict future Charcot neuroarthropathy or infection at that site. Repeat MRIs in 11 subjects with such areas found that none had progressed, six had improved, and two had resolved; in 29 subjects without such areas, five had developed new areas.


CONCLUSIONS
Bone marrow edema in the midfoot and hindfoot of subjects with diabetes and neuropathic lesions is common, often transient, and of unknown significance.
Thorning
Chandani
C
Department of Radiology, St Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, UK
Gedroyc
Wladyslaw M W
WM
Tyler
Philippa A
PA
Dick
Elizabeth A
EA
Hui
Elaine
E
Valabhji
Jonathan
J
D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D002111:Calcaneus / Q000473:pathology*; D015331:Cohort Studies; D017719:Diabetic Foot / Q000453:epidemiology / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000473:pathology*; D004487:Edema / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D013628:Talus / Q000473:pathology*