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Das Knochenödem am Fuß

The bone marrow edema of the foot

  • BEITRAG ZUM THEMENSCHWERPUNKT
  • Published:
Fuß & Sprunggelenk

Summary

Bone marrow edema (BME) of the foot and ankle is a common finding. Based on the causative factors, this condition can be classified into four different groups: mechanical, reactive, ischemic and metabolic BME. Mechanical BME: “Bone bruises”, trabecular fractures, micro fractures and stress fractures. Ischemic BME: osteochondritis dissecans, osteonecrosis. Reactive BME: degenerative or inflammatory arthritis, tendonitis, tumorous lesions, postoperative conditions. Metabolic BME: Transient osteoporosis (syn. bone marrow edema syndrome). The understanding of the causative factors is mandatory to develop a strategy for treatment. Mechanical BME caused by overuse or acute trauma are the most frequent findings in sports. Subtle injuries of the trabecular bone are often not visible on MRI, but can become apparent on high resolution CT. Close cooperation with the radiologist is mandatory to make a precise diagnosis. Nonweight bearing in addition to analgesics and physiotherapy are the major principles in the treatment. However, if possible, local overload or a hind foot malalignment should be reduced by insoles. The off-label use of ilomedin or bisphosphonates can be helpful, although there is still a lack of scientific evidence.

Zusammenfassung

Knochenmarködeme (KME) an Fuß und Sprunggelenk sind ein häufiger Befund. Basierend auf den zugrundeliegenden Pathomechanismen lassen sich Knochenmarködeme in vier Gruppen klassifizieren: Mechanisch induzierte, reaktive, ischämische und metabolische Knochenmarködeme. Die mechanisch induzierten KME umfassen Diagnosenwie das „Bone bruise“, trabekuläre Frakturen und Mikrofrakturen sowie die Stressfrakturen. Ischämisch bedingte KME sind die Osteochondrosis dissecans und die Osteonekrose. Reaktive KME entstehen auf der Basis degenerativer oder entzündlicher Gelenkerkrankungen sowie postoperativ oder bei Weichteilaffektionen. Die transiente Osteoporose (Syn. Knochenmarködem- Syndrom) ist aufgrund histologischer Daten als metabolisches KME einzustufen. Das Verständnis der zugrundeliegenden Pathologie ist der Schlüssel zur Behandlung der Erkrankung. Im Bereich des Sports finden sich überwiegend mechanisch induzierte KME. Dabei sind diskrete trabekuläre Frakturen auf den MRT-Aufnahmen nicht sichtbar, können aber mit Hilfe der hochauflösenden CT dargestellt werden. Die enge Kooperation mit dem Radiologen ist für eine exakte Diagnose von entscheidender Bedeutung. Entlastung in Kombination mit Analgetika und Physiotherapie sind die Grundprinzipien der Behandlung. Wenn möglich sollten Fußfehlstellungen durch Einlagen korrigiert werden. Der „off label“ Gebrauch von Ilomedin oder Bisphosphonaten kann hilfreich sein, eine abschließende wissenschaftliche Einstufung dieser Behandlungsverfahren ist aber noch nicht möglich.

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Authors and Affiliations

  1. Orthozentrum München, Zentrum für Fuß- und Sprunggelenkschirurgie, Harlachingerstr. 51, 81547, München, Germany

    Markus Walther

  2. Orthozentrum München, Radiologische Praxis , , Harlachingerstr. 51, 81547, München, Germany

    A. Stäbler

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  1. Markus Walther
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Walther, M., Stäbler, A. Das Knochenödem am Fuß. Fuss 4, 174–183 (2006). https://doi.org/10.1007/s10302-006-0237-x

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