• 1

    Aigner N, Petje G, Steinboeck G, et al: Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost: an MRI-controlled investigation of a new method. J Bone Joint Surg Br 83: 855, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Hofmann S, Engel A, Neuhold A, et al: Bone marrow oedema syndrome and transient osteoporosis of the hip: an MRI controlled study of treatment by core decompression. J Bone Joint Surg Br 75: 210, 1993.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Van de Berg BE, Malghem JJ, Labaisse MA, et al: MR imaging of avascular necrosis and transient marrow oedema of the femoral head. Radiographics 13: 501, 1993.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Tonbul M, Guzelant AY, Gonen A, et al: Relationship between the size of bone marrow edema of the talus and ankle pain. JAPMA 101: 430, 2011.

    • Search Google Scholar
    • Export Citation
  • 5

    Grimm J, Higer HP, Benning R, et al: MRI of transient osteoporosis of the hip. Arch Orthop Trauma Surg 110: 98, 1991.

  • 6

    Mont MA, Ragland PS, Etienne G: Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res 429: 131, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Disch AC, Matziolis G, Perka C: The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br 87: 560, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Mayerhoefer ME, Kramer J, Breitenseher MJ, et al: Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients. Rheumatology 46: 1460, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Baier C, Schaumburger J, Götz J, et al: Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot. Rheumatol Int 33: 1397, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Grant SM, Goa KL: Iloprost: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in peripheral vascular disease, myocardial ischaemia and extracorporeal circulation procedures. Drugs 43: 889, 1992.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Massari L, Fini M, Cadossi R, et al: Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head. J Bone Joint Surg Am 88: 56, 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Traina GC, Fontanesi G, Costa P, et al: Effect of electromagnetic stimulation on patients suffering from non-union: a retrospective study with a control group. J Bioelectricity 10: 101, 1991.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Savini R, Di Silvestre M, Gargiulo G, et al: The use of pulsing electromagnetic fields in posterolateral lumbosacral spinal fusion. J Bioelectricity 9: 9, 1990.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Aaron RK, Lennox D, Bunce GE, et al: The conservative treatment of osteonecrosis of the femoral head: a comparison of core decompression and pulsing electromagnetic fields. Clin Orthop Relat Res 249: 209, 1989.

    • Search Google Scholar
    • Export Citation
  • 15

    Mammi GI, Rocchi R, Cadossi R, et al: The electrical stimulation of tibial osteotomies: double-blind study. Clin Orthop Relat Res 288: 246, 1993.

    • Search Google Scholar
    • Export Citation
  • 16

    Kitaoka HB, Alexander IJ, Adelaar RS, et al: Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15: 349, 1994.

  • 17

    Doury P: Bone marrow oedema, transient osteoporosis and algodystrophy. J Bone Joint Surg Br 76: 993, 1994.

  • 18

    Hofmann S, Kramer J, Vakil-Adli A, et al: Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin North Am 35: 321, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Bartl C, Imhoff A, Bartl R: Treatment of bone marrow edema syndrome with intravenous ibandronate. Arch Orthop Trauma Surg 132: 1781, 2012.

  • 20

    Tanvetyanon T, Stiff PJ: Management of the adverse effects associated with intravenous bisphosphonates. Ann Oncol 17: 897, 2006.

  • 21

    Elder GJ: From marrow oedema to osteonecrosis: common paths in the development of post-transplant bone pain. Nephrology 11: 560, 2006.

  • 22

    Lecouvet FE, van de Berg BC, Maldague BE, et al: Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol 170: 71, 1998.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Marcheggiani Muccioli GM, Grassi A, Setti S, et al: Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy. Eur J Radiol 82: 530, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    De Mattei M, Caruso A, Traina GC, et al: Correlation between pulsed electromagnetic fields exposure time and cell proliferation increase in human osteosarcoma cell lines and human normal osteoblast cells in vitro. Bioelectromagnetics 20: 177, 1999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Varani K, Gessi S, Merighi S, et al: Effect of low frequency electromagnetic fields on A2A adenosine receptors in human neutrophils. Br J Pharmacol 136: 57, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    De Mattei M, Pasello M, Pellati A, et al: Effects of electromagnetic fields on proteoglycan metabolism of bovine articular cartilage explants. Connect Tissue Res 44: 154, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Ciombor DM, Aaron RK, Wang S, et al: Modification of osteoarthritis by pulsed electromagnetic field: a morphological study. Osteoarthritis Cartilage 11: 455, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Zorzi C , Dall'Oca C, Cadossi R, et al: Effects of pulsed electromagnetic fields on patients' recovery after arthroscopic surgery: prospective, randomized and double-blind study. Knee Surg Sports Traumatol Arthrosc 15: 830, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Treatment of Bone Marrow Edema of the Talus with Pulsed Electromagnetic Fields

Outcomes in Six Patients

Nicolò Martinelli Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Nicolò Martinelli in
Current site
Google Scholar
PubMed
Close
 MD
,
Alberto Bianchi Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Alberto Bianchi in
Current site
Google Scholar
PubMed
Close
 MD
,
Elena Sartorelli Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Elena Sartorelli in
Current site
Google Scholar
PubMed
Close
 MD
,
Alessandra Dondi Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Alessandra Dondi in
Current site
Google Scholar
PubMed
Close
 MD
,
Carlo Bonifacini Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Carlo Bonifacini in
Current site
Google Scholar
PubMed
Close
 MD
, and
Francesco Malerba Department of Ankle and Foot Surgery, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Galeazzi, Milan, Italy.

Search for other papers by Francesco Malerba in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background

Bone marrow edema (BME) of the talus is a rare, mostly self-limiting cause of foot and ankle pain. We sought to investigate in patients with idiopathic BME of the talus the effectiveness of pulsed electromagnetic fields and to determine the effect of this therapy on magnetic resonance imaging findings.

Methods

Six patients with BME of the talus confirmed by magnetic resonance imaging were enrolled. Pain was quantified with a visual analog scale from 0 (no pain) to 10 (the worst pain imaginable). The clinical outcome was assessed using the American Orthopaedic Foot and Ankle Society scoring system. Treatment consisted of pulsed electromagnetic field stimulation 8 h/d for 30 days. The device used generated pulses 1.3 milliseconds in duration, with a frequency of 75 Hz and a mean ± SD induced electric field of 3.5 ± 0.5 mV.

Results

The mean American Orthopaedic Foot and Ankle Society score improved from 59.4 (range, 40–66) before treatment to 94 (range, 80–100) at the last follow-up. The visual analog scale score decreased significantly from 5.6 (range, 4–7) before treatment to 1 (range, 0–2) at the last follow-up. Magnetic resonance imaging showed that BME improved after 1 month of treatment and resolved completely within 3 months in 5 patients, with normal signal intensity and no signs of progression to avascular necrosis.

Conclusions

A significant reduction in BME area was associated with a significant decrease in pain within 3 months of beginning treatment.

Corresponding author: Nicolò Martinelli, MD, Department of Ankle and Foot Surgery, IRCCS Galeazzi, via R. Galeazzi 4, Milan, 20100, Italy. (E-mail: n.martinelli@unicampus.it)