Abstract des Autors

Bone marrow edema (BME) of the foot and ankle is a common finding in sportive people. Based on the causative factors, this condition can be classified into four different groups: mechanical, reactive, ischemic and metabolic caused 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, however, BME can be find in up to 80% of pain free runners. Edema caused by overload can hardly be distinguished from subtle injuries of the trabecular bone. Especially tiny micorfracutres are often not visible at the MRI, but can become apparent on high resolution CT. A close cooperation with the radiologist is mandatory to make a precise diagnosis. Non weight bearing in addition with 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. Verf.-Referat