Foot pain frequently associated with vitamin D deficiency: Bone marrow edema syndrome

Özet

Aim: Bone marrow edema syndrome (BMES) describes non-specific, ill-defined areas of hypo intense and hyper intense sig-nal on T1 and T2 sequences, respectively. BMES has unknown etiology and resolves without sequel. In this study, we aimed to evaluate the initial clinical and radiological features and clinical course of patients with standing BMES. Method: We evaluated 19 feet of 17 patients who applied to our clinic between January 2014 and December 2016. X-Ray and MRI were taken in patients with clinical suspicion of BMES. Initial vitamin-D levels, hemogram, sedimentation, C-reactive protein (CRP), rheumatoid factor (RF) and Anti-CCP values of patients were evaluated. After the diagnosis, indomethacin and vitamin-D therapy and weight-bearing protection with double crutches was given for 6 weeks. Result: All patients mentioned that sudden onset of pain. The mean duration of symptoms was 7.12(2-20) months. Mean se-rum 25(OH)D level was 14 IU, sedimentation values were slightly higher in 7 patients, CRP, RF and Anti-CCP values were normal. BMES mostly detected in talus. The mean AOFAS score of the patients was 63 and the last control was 92. Conservative tre-atments should be considered as the first-line treatment option in BMES. Conclusion: The importance of laboratory tests in BMES should not be forgotten. Vitamin-D may play a role in the etiology of the disease. For that reason, patients need to be investigated in that way.