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Molly Maloof, MD

Director of Clinical Content

Bone marrow oedema

Bone marrow oedema diagnosed 4 months ago in the shaft of 2nd metatarsal and cuneiform bones of my left foot after sudden onset of foot pain while walking. I have bilateral OA of 2nd TMT joints - worse on the right, relatively minor on the left. Worn an Aircast boot allowing protected walking. MRI repeated 2 weeks ago showing slight reduction in the bone marrow oedema only. Advised to walk short distances without boot - pain now worsened. NSAIDs not taken. Where do I go from here?
  • Female | 59 years old
  • Medications: Sinemet pramipexole
  • Conditions: Parkinson's

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Featured Answer

1 UpVoted this answer Bernabe B. Canlas, DPM Podiatrist, League City
The fact that you already have a diagnosis of osteoarthritis in the joint where you have the bone marrow edema may correlate with the findings of the MRI. It is still possible to have a stress fracture in this area and typically your physician reading the MRI can differentiate the difference between an acute osteoarthritic Flare vs a stress response in the bone. It seems as if the time spent in your boot was possibly too short and it may make sense to wean out of the boot a little slower in order to allow the inflammation more time to reduce in and around the involved joints. If it is in fact an arthritic flare, you may respond well to a short term Course of anti-inflammatory medication at the lowest possible dose. If indeed it is a stress response in the bone, you may respond better to continued rest and immobilization and it may make sense to have a vitamin D level drawn to determine if the stress response is related to deficiency in your bones ability to heal. Wish you well.
1 UpVoted this answer Peter L. Schwartz, MD Plastic Surgeon, Woodbury
The probable diagnosis is an unhealed stress fracture at the second metatarsal. An exogen bone stimulator used half an hour per day may promote healing. NSAIDs actually inhibit fracture healing.
Michael J. Katz
Cast with complete NWB.
I would keep an open line of communication between you and your orthopedist and/or podiatrist. Edema is a sign of inflammation. Inflammation is part of healing, but sometimes anti-inflammatories such as NSAIDs or Tylenol may help to moderate the effects of inflammation. However, these medications are contraindicated in some patients and certain health conditions.

I hope this helps!!
Sounds like a stress fracture. Seek professional dpm/podiatrist for help. Below knee cast advised to immobilize your forefoot. Best of luck
Alex Kheynson
Bone marrow edema on MRI indicates extra stress at this location. Even though no fracture is identified, it should be treated as such. A longer period of time in the boot is needed. Possibly orthotics (custom insoles) a consideration as a long term solution.
Seth Steber
I'm a plastic surgeon.You should consult with a internist.

Dr Farahvash
How long did you use the airiest? Did you use it all of the time? Most likely you have a stress fracture and may benefit from a bone stimulator.
Jerald Askin
I'd recommend an orthopaedic evaluation of the LisFranc joint/ligament. The edema is likely a response to the arthritis. While surgery may be helpful, a fusion has a higher failure rate in patients with Parkinon's.
Not my area of expertise

Advise consultation with Medical Oncologist and/or Orthopedist both of which should be board certified

Anxious how you do.
W. Ray Henderson