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Running Injuries Foot Stress Fractures vs. Bone Marrow Edema in Runner’s feet

Foot Stress Fractures vs. Bone Marrow Edema in Runner’s feet

3 Minute Video: Bone Marrow Edema Compared to Stress Fractures

Dr. Runco recently helped two patients that had each been experiencing foot pain for two years. Read on for his personal account of helping these patients get the proper diagnosis (differentiating between stress fractures and bone marrow edema) and treatment for their conditions.

Case 1: Misdiagnosed Bone Marrow Edema

I had the opportunity to examine a young 14 year old cross-country runner yesterday.  She has suffered from 2 years of foot pain. Unfortunately she has been the victim of  mis-diagnosis.

Foot Pain Symptoms

She explained that the pain stays fairly constant (a 5 on a 1-10 scale) and gets progressively worse when she runs. Her mother told me that she had X-rays and MRI’s a year ago that were “negative”.  They did not bring the images to their appointment but I was highly suspicious of the result.  In the world of diagnosis there is always a logical reason for a runner’s pain.  If the attending physician is not used to seeing running injuries than that logical reason may not be so obvious.  In my world, where 80% of my patients are runners it is very obvious.  She explained that the pain is near her 3-4th metatarsal on the top of her foot and that on occasion her foot will swell and “turn colors”. 

Stress Fracture/Bone Marrow Edema Testing

I began the exam the way I begin all exams of this nature.  I asked her to stand up and hop up and down on the painful foot.  This is called the “jump test”. When she hopped the pain worsened significantly, suggesting stress fracture.  There is another, less known condition called Bone Marrow Edema which can also hurt during the single leg jump test so I continued with my exam.  I next used a pulsed ultrasonic wave over the involved area.  Normally the runner will feel nothing.  If there is a fracture they will feel pain…and she did.  I wanted to confirm the diagnosis so I used a tuning fork to create vibration over the injured area.  This too caused significant pain. 

Bone Marrow Edema Diagnosis

At this point my exam was over with a working diagnosis of Bone Marrow Edema.  Why Bone Marrow Edema versus Stress Fracture you may want to know?  Because she had previous x-rays and an MRI which supposedly did not show a fracture. I have to assume they were accurate, at least until I can personally view them.  Since Bone Marrow Edema presents in much the same way and will react to the same set of testing but not show on X-ray that became the working diagnosis. 

X-Rays and MRIs as Diagnostic Tools

The patient was instructed to get another X-ray and retrieve all of the old tests so that I could review them.  I explained to her mother that “I treat patients not their MRI”.  It is common for X-rays and MRI’s to be inaccurate.  X-rays often do not show stress fractures and can not show Bone Marrow Edema.  MRI’s are often mis-read or not interpreted accurately.  It is common for me, after receiving the Radiologist report to call the Radiologist and ask them to look at the MRI again.  This second time they have me literally in their ear going over all of the patients complaints.  It is not unusual at this time for the Radiologist to say “well, maybe I do see this or that in that area.  How about if I send you over an addendum to my report”?  What I have come to realize is that MRI’s are not as specific as you are led to believe! 

Let’s look at another example that occurred in my office the exact same day.

Case 2: Doctor Explains MRI Results Incorrectly

A young man presented with a 2 year history of pain on the top of his foot that would get progressively worse as he ran.  He was seeking a second opinion as he had already seen a podiatrist who had ordered an MRI.  The podiatrist told him the MRI was “negative”.

Stress Fracture/Bone Marrow Edema Testing

I went through the same 4 exams as I had with the cross country runner earlier in the day.  This time there was a negative jump test, negative ultrasound, negative tuning fork and no pain with deep pressure anywhere on the muscle, tendon, joints or bone.  I said “Well nothing is testing positive so without seeing the MRI I have to speculate that whatever was wrong finally healed”.  At this point he said “Oh, I have the MRI report right here”.

What the MRI Actually Said

He handed it over and I immediately went to the report conclusion, “There is acute marrow edema along the plantar aspect of the first metatarsal head with sub adjacent marrow edema in the first tibial sesamoid”.  I turned to the patient and read it aloud while wondering why on earth the podiatrist would have told him his MRI was “negative”.  In this case the MRI was right on…..the doctor was “negative”!

Bone Marrow Edema After-Care

I explained to the patient that since he had been resting for so long that his injury was mostly healed.  We had a conversation about how stress fractures and bone marrow edema occur and I asked him to resume running and send me a follow-up email in 2 weeks so that I knew his injury was continuing to repair and heal.

Stress Fracture and Bone Marrow Edema Similarities

Common areas for stress fractures to occur in runners are in the sesamoid bones, 1-3rd metatarsals, 5th metatarsal, the tibia near the ankle and the tibia near the knee.  Sometimes a runner can develop bone marrow edema.  In this situation the bone swells inside and results in similar pain that stress fractures produce.  Both injuries are commonly mis-diagnosed as shin splints and other sprain/strain injuries.

Bone pain typically gets progressively worse during a run while muscle pain will often “warm up”.  Of course there are always exceptions to this rule.  Limping after running is a common sign of marrow edema or stress fracture.  If hopping up and down on one leg reproduces pain stress fracture is likely and continuing to run will only worsen the situation. 

Treating Stress Fractures and/or Bone Marrow Edema

When accurately diagnosed early, stress fractures and bone marrow edema can heal quickly.  Measures then need to be taken to prevent future occurrences.  At SDRI we evaluate lower body strength, running biomechanics and nutritional status.  Any of these variables can result in a runners bones not being strong enough to withstand the repetitive nature of long distance running.

Both of these conditions are treated in similar ways, with rest being the number one prescription. SDRI also offers the Anti-Gravity Treadmill. This lets patients actually run, even when injured, because the Alter-G negates their body weight.

Check out this PDF for more information on Stress Fractures.

 

Comments

Evan 25-09-2014, 03:34

Thank you for this article. It was very helpful, because I just started cross country , and I had similar problems as these patients! The doctor told me to sit for three weeks from cross country and soccer, because he said I have bone marrow edema and stage 3 tibial stress syndrome. Is tibial stress syndrome just shin splints or is is something else?? I just want to make sure because I have soccer tryouts soon, and i want to be healthy enough for that.

Thanks a bunch!

Dr. Runco 25-09-2014, 13:49

stage III medial tibial stress syndrome and bone marrow edema are considered “pre-stress” fracture Evan. Shin splints is a catch all term for pain in the lower medial legs. What it means is that your muscle (Tibialis posterior) is “splinting” in response to injury to either the muscle-tendon itself or to the bone. The bigger question is why did you get it and how will you prevent it from happening again?

Christy Hogan 25-09-2014, 15:09

My 11 yr old son was just diagnosed with bone marrow edema in his left foot. In May of this year he fell into our swimming pool that was under renovation. He landed on his feet but also broke 3 bones in his left foot. He was in a cast for 5 weeks and then new shoes with inserts that we bought from his foot doctor. He has had pain in his heel ever since his cast was removed in early July. The doctor at first said he had calcaneal apophysitis and to rest it and Motrin 2/day. It’s almost been 3 months since his cast was removed and it still hurts him and he limps. The doctor just read his MRI and believes he has bone marrow edema. What should we do now for treatment? Thank you for your help.
Christy

Dr. Runco 26-09-2014, 12:17

1. get a new doctor
2. stop wearing the inserts the doctor gave your son
3. I would have to see the MRI to know if the diagnosis is true
Does your son have heel pain? Arch pain? Are the inserts the doctor gave hard?

Stacie 01-10-2014, 14:55

Question regarding your opionion:
heel pain Started in July – responded well to one steriod injection, however came back and was painful just to weight bear. Had MRI which showed:
Mild marrow edema within the calcaneus subjacent to origin of medial bundle
plantar fascia likely reactive to mild acute on chronic plantar fasciitis-type
changes. Remainder of the calcaneus is within normal limits.

Additionally, the radiologist does discuss
mild excess fluid in the posterior tibialis tendon sheath with mild
tenosynovitis.
There is some fluid signal which appears to arise deep to the extensor hallucis longus and
digitorum longus tendons and insinuate into the region of tarsal tunnel. This
would be most compatible with developing ganglion.

Had second steriod injection at 5 weeks, wore walking boot for 3-4 weeks all the time, then for 4 more weeks at work. Acupuncture. For Exercise, just swimming and biking for 3-4 weeks, progressed to cross training/stairmill @ gym 2 x / week. Attempted 2 mile run a few days ago and foot was still VERY sore after. Dr recommended PRP injection… your thoughts?

Dr. Runco 02-10-2014, 12:25

Your MRI reads like a novel. Bone marrow edema, tenosynovitis, ganglion in the tarsal tunnel…..you said your heel pain started in July. Is it only in your heel? Here are a few questions if you can answer them
1. Do you have pain in the morning when getting out of bed in your heel? If so does it progressively warm up?
2. Do you have pain in your heel when getting up after sitting for prolonged periods? Does it progressively warm up?
3. If the above answers are yes does stretching your calf help alleviate it?
4. Is the pain in the bottom of your heel towards the beginning of your arch? Or is it in the central heel? Or is it on the inside/medial side?
5. Do you get any “burning” pain or numbness?
6. Where sis the doctor inject the cortisone? How well did you actually respond? Meaning were you running after it? How long did it alleviate the pain for?
7. Do different shoes or no shoes help or make a difference?
Stacie you could have a number of things. Heel pain can be caused by plantar fasciitis, heel spur formation, joggers foot (entrapment of the medial calcaneal nerve), Tarsal Tunnel Syndrome and stress fracture or bone marrow edema to name a few. Your MRI shows a couple of things so more info would help me. You can email me directly at DrRunco@sdri.net

Elaine 25-11-2014, 03:01

I was diagnosed with plantar fasciitis over 15 years ago. I have high arches and pronation. It has come and gone over the years; sometimes helped by the kinds of shoes I wear. For the past 1.5 years, it has become increasingly worse/very painful. I’ve had cortisone injections (6 total), physical therapy, night splint, two different anti-inflammatories for another each, two rounds of oral steroids, new orthotics. Only received temporary relief with some of these treatments. Switched docs, got an MRI (and bloodwork to rule out RA-which it did). MRI showed plantar fasciitis, moderate to severe plantar fasciosis, heel spur, and bone marrow edema. Doc suggested hard cast/crutches for 6 weeks. Also offered topaz as an alternative (since casting not very practical for me). Since then, went on vaca and did lots of (painful) walking. Now have burning pain up back of heel. Could this indicate a stress fracture? Would topaz help bone edema?

Dr. Runco 02-12-2014, 15:12

It sounds like you are in a lot of pain and will try just about anything? In that case I guess you could try the Topaz. I had never heard of it (until now) so had to go look it up and read about it.
You might consider platelet rich plasma therapy and rocker bottom shoes like the old Skechers Shape up…..lots of people with chronic heel pain like those a lot as they allow for pressure to be redistributed off the heel

Jill hunt 14-12-2014, 15:02

I have been seeing a foot doctor for years off and on. In the past I have had plantar fasciitis. About 6 months ago I went back with foot pain and they assumed it was again plantar fasciitis. After treatment wouldn’t help and telling them repeatedly that it got worse after moving not after rest they have done an MRI and diagnosed me with Bose marrow edema and bone inflammation. I have now been on anti inflamatories twice a day for several weeks. For the past months I have been on them daily and had cortisone shots. I am still having pain in my foot after a long day without even doing any stenious exercise. I live in the Orlando area do I need to see someone new? So ready to get back to exercising!
Thanks
Jill hunt

Dr. Runco 18-12-2014, 19:31

Hi Jill,
If you can email me a picture of your foot (mark the spot so I can see where the pain is) and a copy of your MRI report I will better be able to assist you.

Cha Disa 27-02-2015, 15:13

DR. Runco,
I Went on trekking 8 months ago and it was 4-5 km of walking.. After two weeks started pain in my knee, there after pain of sole while walking first few steps in the morning.. Then consultant orthopedic surgeon was diagnosed as I am having plantar fasiciatis..X ray was taken and nothing wrong with the knee..Did CCP, ANF and CRP Tests.. All were negative..Even Dexa scan ì&showed negative results..According to consultant took some NSAID, used heel pads and did pysiotherapy. But heel pain was persisting. Then went to a rhumatologist and she reccomended a steriod injection for plantar faciattis. It was done 2 months ago and no any relief..Now pain is radiating to toes, ankle and achillies tendons also..Now walking early morning is not problem.. But whole day is having pain..Even cross legs also given pain to heel area..No knee pain.. Now Rhumatologist is suggesting to do a MRI for foot.. What about your opinion on this? Could this indicate as stress fracture?

Dr. Runco 28-02-2015, 12:24

maybe. An MRI won’t hurt but stress fracture is possible however unlikely. Let me know the outcome

pankaj 12-03-2015, 08:48

the mri report of my fathers age 63
Marrow edema of lower metadiaphyseal regions of tibia seen with edema of surrounding musculo fascial soft tissues-? infective ( osteomyelitis)

Mild ankle joint effusion seen

Osteo arthritic changes are seen in knee joint with grade 111degene tear of posterior horn of medial meniscus.
he has treated with
Stafcure-LZ (Cefuroxime + Linezolid) and Signoflam (Aceclofenac) since 12 feb he has taken these medicine
still there are some pain and swelling please guide us

pankaj 12-03-2015, 08:49

the mri report of my fathers age 63
Marrow edema of lower metadiaphyseal regions of tibia seen with edema of surrounding musculo fascial soft tissues-? infective ( osteomyelitis)

Mild ankle joint effusion seen

Osteo arthritic changes are seen in knee joint with grade 111degene tear of posterior horn of medial meniscus.
he has treated with
Stafcure-LZ (Cefuroxime + Linezolid) and Signoflam (Aceclofenac) since 12 feb he has taken these medicine
still there are some pain and swelling please guide us

Dr. Runco 12-03-2015, 15:57

if he has infective osteomyelitis he needs to see a doctor quickly. It means his bone is infected with bacteria and is very serious.

Dr. Runco 12-03-2015, 15:58

infections of the bone is the most likely diagnosis. It is bacterial and if treated early and quickly can be a good outcome

Marissa 17-03-2015, 20:21

Hi Dr. Runco,
I’ve had pain in my 3rd through 5th metatarsal area since August 2014. It came on very suddenly and an MRI first showed stress reaction in 3rd phalanx (which is very uncommon) so I stopped running. I’m on the varsity XC/track team at Harvard and all year I’ve been unable to compete and it’s devastating. I did start running for a few weeks without pain in December, but it came back and I stopped running again in Jan. My most recent MRI shows bone edema in the 3rd, 4th, and 5th metatarsals. I’m very skeptical of a stress reaction since I have been non-impact for over 2 months, and even wore a boot on my bad foot for most of that time but haven’t seen much improvement. I do have a history of CRPS in my right knee and my orthopedist thinks this may be another bout of neuropathic hypersensitivity so prescribed gabapentin and I have noticed some improvement. Any thoughts/suggestions? Thanks.

Virginia Wallace 18-03-2015, 03:29

Dr. Runco

I was diagnosed with an stress fracture 6months ago. Doctors are now saying I don’t have a stress fracture. Most likely I never one, or it’s healed. I’m still having pain and swelling in my left foot. I can not put weight on the foot without limping. I’ve had X-ray, MRI, and an CatScan. The Podietrist seem to be at lost as to what’s going on with my foot, he even ordered blood work. He said all test are negative. I didn’t have an injury to my foot. nor was I a runner.

Meghan 22-03-2015, 03:43

Hi, I am a long distance runner in college and about 5 weeks ago I started developing a pain in the inner area of my shin, pain is about 1-2 inches in length. However it is more behind the bone and along the tendon. I have continued to run on it, as it feels better once it’s warmed up. I can do the one legged hop test fine when I am warmed up. If I were to just do it randomly I have little strength to even push off. It also hurts more in the morning but loosens up. I ran a half marathon on it 2 weeks ago and was fine and just raced a 5k and it was fine , however it bugs me on normal training days. I went to a physio therapist last week and she said she doesn’t think it’s a stress fracture because she can hit all along the bone and I feel no pain. She said that my calf muscles were just really tight… The pain also tends to spread to my upper calf, and all along the outer part of my shin. What are your thoughts?

Dr. Runco 23-03-2015, 11:01

you either have
1. Shin splints (posterior tibialis tendonitis)
2. Stress fracture
3. bone marrow edema
It could be from over-training, shoes or possibly you need an insert

Dr. Runco 23-03-2015, 11:02

if you are not a runner what sport do you do? How would you get a stress fracture?

Dr. Runco 23-03-2015, 11:04

does it hurt to go up and down on your toes? Do you ever get burning pain into your toes?

Salvatore Giametta 05-04-2015, 12:35

Good afternoon,

My name is Salvatore Giametta. 32 year old male, active soccer player since the age of 4 and active weight trainer. On November 15th 2014 I was injured in a soccer game. First 2 initial x rays were negative. Doctor advised me to continue normally until I felt pain then to cease activity. I went in for another x ray with another doctor and x ray showed a healed fibula fracture (early march). I was playing maybe once a week during end of jan and feb. Doctor told me to stop all sports related activities. Went for an MRI last week and results showed a fracture of the distal left fibular shaft, moderate bone marrow edema and mild associated soft tissue edematous changes. Was told today 3 months no soccer. I am pretty upset about this. Just saw your video on youtube. Would like a phone consultation and treatment protocol as I live in NYC.

Best regards,
Salvatore.

Dr. Runco 06-04-2015, 16:03

Hi Sal,
If you call my office at 858-268-8525 and leave
1. Your full name number and that you would like a phone consult
2. a time(s) you will answer to avoid playing phone tag
Please take a picture of your X-ray and MRI report and email it to me
Please mark the spot on your leg that hurts, take a picture and email that to me as well

Roi 14-06-2015, 11:46

Dear Dr. Runco,

4 months ago I had a car accident: I was crossing the street as a car took a turn near me. The front of the car did not hit me, only the rear wheel (as the car was passing behind me) “clipped” the heel of my right foot. I was wearing “standard” Nike shoes. I am a 34 year old otherwise healthy male.

There was almost no pain involved, just a couple of sharp pain pangs which disappeared. The following weeks I had dull pain in my heel, but it was very manageable. I had zero problems jumping on my toes etc. I go to the gym 4 times a week and start with a 10 minutes run – and kept doing so after the injury.

I had various episodes of the pain going away, and then I intensified my training, only to see the pain return. Eventually I went to a foot and ankle orthopedist to complain about the pain. The X-ray showed nothing and she ordered an MRI. The MRI results were: “There is subtle, patchy hyperintense T2 signal in mid to posterior calcaneus, without acute cortical irregularity or disruption” and “There is subtle, hyperintense T2 signal within sinus Tarsi fat”. Under Impressions she wrote: “Mild, bone marrow edema in mid to posterior calcaneus without obvious fracture; Mild sinus Tarsi fat edema, probably reactive, possibly secondary to altered weightbearing”.

Since taking the MRI test but before my doctor explained the results I did another exercise which caused me pain – I lay down on my back on wooden floor, wearing socks, pushing my heels into the floor thereby curving my body (it was supposed to be a hamstring exercise; stupid, I know). Since my orthopedist explained what I had I tried to take it easy even more. Again there were episodes when I felt good but it only took a long walk to bring the pain again.

Unfortunately my doctor has relocated and I had to set an appointment with a different foot and ankle orthopedist – which is going to take some time now. Therefore, I’ve decided to take it to the extreme – I bought a knee scooter which I’ve been using for 5 days now, except when I’m home (I don’t do much walking home) to offload my heel. So far the pain isn’t going away, but there’s an improvement when my body is “warm”; I feel the full pain much more when I’m lying down and resting for a long period, less so if my body is active (while using the knee scooter).

I am wondering what course of action I should be taking, and what my diagnosis is? Could it be that in the 2 months since my MRI test I have worsened my situation, perhaps broken my heel bone? It is confusing, because the pain is dull and difficult to locate, so please take this with a grain of salt: I feel as though there are two “sources” to my pain; a mild one in the calcaneus (lower part), and a more intensive one on the upper side of the bone (if the source is at all the bone; it could be a soft tissue for all I know), with a more “burning” nature to it, that if I wrap with a cold patch for 15 minutes, quiets down.

What are your thoughts?

Respectfully,

Roi

P.S. Other aspects of the MRI report, just in case they are valuable:
“Visualized Achilles tendon is grossly unremarkable without signal abnormality or contour irregularity.

Visualized peroneus, posterior tibial, anterior tibial, flexor hallucis longus, extensor hallucis longus, extensor digitorum longus, flexor digitorum longus tendons; talofibular, tibiofibular, deltoid, calcaneofibular ligaments are incidentally grossly unremarkable.

Plantar aponeurosis is grossly unremarkable. Ankle mortise is grossly maintained.”

Dr. Runco 15-06-2015, 12:39

Something is not adding up. I would require a lot more information. Would you like to set up a phone consultation?

Megan Mathews 07-07-2015, 06:14

AS SOMEONE THAT SPECIALIZES IN “RUNNING,” WHAT IS YOUR TAKE ON THE FOLLOWING…(note: I did nothing in particular to hurt myself…and I was running only 12 miles per week. I started bruising and getting a lot of pain on weight bearing):
IMPRESSION:
1. Superficial partial tear of the peroneus longus tendon as it
courses under the inferior lateral cuboid bone.
2. Mild posterior tibialis tenosynovitis.
3. Partial sprain of the fibular attachment of the posterior
talofibular ligament with associated bone marrow edema in the fibula
but no demonstrated fracture. Anterior talofibular ligament and
calcaneofibular ligament are normal.
4. Small tibiotalar and subtalar effusion.
5. Mild degenerative changes of the talonavicular joint.

Dr. Runco 07-07-2015, 07:01

Considering that I only have your reported MRI findings I will try to explain them in some detail and then ask you a ew follow up questions Megan.
It appears that at some point in your life you suffered from an ankle sprain (rolled ankle) and that left some damage. I say this because of the injuries and damage reported on the lateral side of your ankle.
Secondly it is probable that when you run you are landing on the outside of your foot which would explain the injuries as well. So if we assume you have some old damage in the outside of your ankleand then it is flared up and made worse by either your high arches or your style of running then we have a plausible explanation for what has occured in your foot and ankle.
A better question is what are you going t odo to get this better?
Megan do you
1. Have a history of injuring that foot and ankle?
2. Do you have high arches?
3. What type of running shoe do you wear?
4. Do you know how you run? How you land?
5. If you look at the bottom of your running shoes can you see where there i heavy wear pattern? You can take a close up picturre and email it to me.

Megan Mathews 07-07-2015, 07:47

Thank you for responding…1. I have no history of ankle injury. Could my ankle be arthritic? 2. Yes. I have high arches. 3. My last three pair of running shoes have been ASICS. Just bought a new pair with athletic inserts. 4. I think I underpronate (?). 5. The wear pattern shows most on the outer back side of the heel. I do not have access to my shoes at the moment. It’s been two months since the onset of my ankle problem. I ran 1.5 miles last night for the first time in two months, which did cause a lot of pressure on the outside ankle and above — and pain on the inside/front ankle and top of foot. (I will probably invest in an exercise bike since it looks like I will not be able to run yet for a little while.) Other than doing “nothing,” I’m not sure what to do — possibly PT (I haven’t decided yet).

Christie 10-08-2015, 05:39

I was diagnosed with a MRI of having faint marrow edema present in the head and neck of
the 2nd metatarsal. No fracture line identified. No periostitis. No joint effusion. The Lisfranc joint is intact. Normal muscle signal intensity. No soft tissue fluid collection. The included flexor and
extensor tendons are intact. The tibiotalar joint and sinus tarsi are unremarkable. The Achilles tendon and plantar fascia are intact.

I am currently in a boot but when I get out of the boot I want to make sure it doesnt come back. I had $500 customized orthotics made, is there anything else I might need like metatarsal pads?

Thank you for ANY tips!

Dr. Runco 10-08-2015, 05:56

Why do you think you got the injury this time Christie? I hope the orthotics that were made for you are
1. Comfortable
2. Practical
3. Effective
I am guessing you will be in the boot for 6 weeks. I am also guessing you suffered the injury from overuse or not resting enough in between running or some other high impact sessions. Recovery is key. There is no orthotic or metatarsal pad or any other device that will prevent injury. If we run long enough or far enough without enough recovery injury will occur.

Christie Achenbach 11-08-2015, 03:31

Thank you Dr Runco for your response. I am guessing I was injured because of poor biomechanics developed over time and running on a hard surface. However, I only ran for about 2 months before I stopped and only ran between 5-20 min at a time 1-5x week. I am also guessing my second toe takes the impact because of the biomechanics issue? Can the bone marrow edema also feel like a tendon problem? If I move my foot a certain way I can feel it underneath. Again, thank you so much for taking the time to respond, it is greatly appreciated!
Christie

Dr. Runco 11-08-2015, 04:59

It is more probably that what you are feeling is the plantar plate ligament. MRI often misses injury to this small but critical ligament.
It does not sound like you “overr-used” your foot resulting in the injury. Possibly due to poor mechanics…..do you have any other foot issues….bunions for example or anything else

Christie Achenbach 11-08-2015, 09:45

No other foot problems! Should I return to my doctor ASAP to reevaluate my MRI? Thank you so much!

Dr. Runco 11-08-2015, 10:55

Christie the MRI does not always show this small ligament as it may not be sensative enough to pick up the tear.
1. Take a picture of your feet looking down on them first sitting and then standing.
2. Mark the spot on your foot where it hurts email that to me too
3. Does your foot hurt if you stretch your toe(s) back towards your shin?

Kyla Vaeth 08-09-2015, 10:14

Thank you,

2 years ago rolled my ankle. I have had MRI all saying the same thing bone marrow edema. The doctors tell me R.I.C.E. It Hurts in the same spot where my tibia meets the ankle. I can no longer run, carrying or lifting weights or carryi g my niece hurts, walking is beginning to hurt and it doesn’t take much for my ankle to go out on me agian. I’m beginning to think I’m gonna have to deal with this the rest of my life and I’m only 34. Any advice would be great.

Dr. Runco 09-09-2015, 07:47

you may need an MRI with contrast. This may show ligament damage…..or not. If after 2 years the pain is still that bad it is “implied” that something was missed on the first MRI.

David Fung 12-09-2015, 11:46

I had pain in my ankle for about 1 and half years. I went to many orthopedics and 2 out of 3 only did xray. The last one told me to get a mri and I was diagnosed with bone edema within the accessory navicular and primary navicular bones consistent with painful navicular syndrome. I’m scare that it might be a permanent damage. Is there anyway I can treat it or type of doctor I can go to? Thank you

Dr. Runco 14-09-2015, 07:18

You can try custom insoles David…..the surgeons will probably offer you surgery to remove the accessory navicular bone which is a viable option. Where do you live? Do you want more help or advice? Please respond to my personal email DrRunco@sdri.net

Walter 21-09-2015, 23:12

I am 30 years old. It all started by doing a lot of jumping exercises and soccer. At the beginning it was my big toe. The pain was very little but then at my last soccer game, thats when i had to stop so in agoust 5th my doctors orders a x ray. The xray showed nothing. He put me to rest for 8 weeks with a boot and crutches. I went back and told them i felt the same so i get an mri done in september 18. He tells me in the report shows maybe a stress fracture below the big toe inflammation in my 4th and 5t metatarsal and little star of arthitis. Now i have been out of work for 2 month and i told him i cant do this anymore i need to go back to work. So my question can i have a surgery done for this? Can i send you the copy of my MRI. So you can have a look? I just want to walk without any pain. Rigth now im just walking without the boot or crutches. The pain is not really bad but i know for sure i cant run and i dont want to play soccer either until i can feel i can. Thanks

Dr. Runco 22-09-2015, 05:28

It sounds like you have been misdiagnosed Walter. Please take a picture of your MRI report and email it to me at DrRunco@sdri.net I would also recommend a phone consultation by calling 858-268-8525 after 12 noon PST today. After I review the MRI report and talk to you regarding your current symptoms I will email you a written treatment plan to get you back to work and playing soccer asap

Angie 26-09-2015, 14:44

My 8 year old daughter twisted her ankle over 8 weeks ago. After visits to multiple doctors, ER and urgent care visits because of the pain, she was diagnosed with “bone marrow edema like changes within the distal aspect of cuboid” following an MRI that I had to request. She had two previous xrays that were negative and the MRI didn’t show any fractures either according to the radiologist that read it. After the injury, she was still able to walk with pain. We got her a boot that seemed to help, but continued to have pain. She then seemed to have been getting better, then overnight about 6 weeks after the injury, she now can no longer bear weight, vibration, bubbles or even lightly touching her skin without being in pain. There is still very slight swelling. The last doctor prescribed 6 weeks of PT, but we’re concerned this will make it worse. She has never been put in a cast or been prescribed any kind of devices to assist her. We had to buy her boot and crutches on our own because all the doctors she has seen kept telling us it was just a sprain and she’d get over it and basically told us to quit bringing her to the doctor and that she would be fine in a couple of weeks. Now, we’re 8.5 weeks in since her injury and she is still on crutches with no signs of improvement. PT hasn’t started yet because we’re still waiting on the referral. We want to get another opinion from another local physician, but while researching I came across this site. Thank you in advance for any insight you can offer.

Dr. Runco 28-09-2015, 10:04

Where do you live Angie?
Can you take pictures of the MRI reports and xray reports and email those to me please? Drrunco@sdri.net

Kimn Chartier 30-09-2015, 19:22

Hi Dr. Runco, loved your article. I have had MRI after MRI and I’m going crazy! I tore my plantar plate and had it repaired Nov 2014, still feels like I’m walking on a sock that’s bunched up! Anyway, I’ve been having problems with same foot but this time it’s the third toe. Lots of swelling and painful with no recent trauma. I asked Dr to order another MRI and now it shows INTENSE BONE MARROW EDEMA suggesting osteomyelitis. WBCs are normal, sed rate is normal and so is my CrP. I told my dr that I had hit my foot so hard before the Nov surgery and felt like my foot was fractured.. He went back and said it now looks like it!! I’m so confused! MRI said I had no stress fracture.

Dr. Runco 01-10-2015, 06:01

your doctor is…well…not competent it seems. The MRI does not show a fracture so there is no fracture. It does show bone marrow edema which is essentially like a internal bone bruise with swelling inside the cavity of the bone.
Have you been running since the surgery in November? Also the radiologist wanted to make sure you have no bone infection resulting from the first surgery. It appears your blood work and MRI confirm the lack of infection….that is good. Kim the below explains HOW one develops plantar plate injuries. The newer injury to your third plantar plate seems t ofall into category 1 “Transfer Injury” possibly after the surgery you began shifting weight away from the second to the third metatarsal and unfortunately the third met is not designed to bear the load.

1. The most common is transfer pain from abnormal weight bearing due to problems with the first toe. So problems like bunions or painful first metatarsal-phalangeal (1st MTP) joint can result in excessive weight bearing on the second metatarsal-phalangeal joint (2nd MTP) resulting in a slow and chronic tearing process. Initially the pain is referred to as metatarsalgia…which means “pain in the metatarsal”. The pain is due from repetitive micro-trauma to the 2nd MTP. This results in micro-tears that can even evade scrutiny by MRI! Over time the micro-tears and split and become grade 1-3 tears…..which is bad, bad ,bad. Bad because it results in pain, disability, no running, surgery or months in a walking boot unless you know how to treat it effectively….and I do.

2. While running or walking if you step on a sharp or hard rock in just the right way you can tear the 2nd plantar plate. In this case the pain is not present…then it is immediately following the incident. This is a trauma to the 2nd plantar plate and can result in the same dire set of circumstances.

3. In dancers that wear high heels which transfers all of their body weight onto the ball of their foot and 2nd MTP. Imagine a profession that might fit this description…wearing heels all the time and you will see lots of plantar plate injuries. Cocktail waitresses, dancers etc can get this.

4. People, especially women with high, rigid arches (Pes Cavus Rigidis) are prone to this. In this case the person bears all of their weight on the 1st and 2nd MTP’s due to the genetic anatomy of having high arches. Over time this can result in repetitive micro-trauma to the plantar plates.

5. Runners. Runners push off their 1st and 2nd MTP’s while in the “toe-off” portion of the gait cycle. Depending on the amount they pronate might depend on the amount of weight transfer from the first to the second plantar plate. Too much stress on the second plantar plate without adequate recovery time and a tear can result. The further you run also increases the risk which is why it is so prevalent in long distance runners.

as with any injury if a plantar plate tear/sprain is identified early the treatment to fix it is conservative and with a high success rate. The worse the injury the less likely conservative treatments will work and the person ends up undergoing a painful surgery often forever altering their skeleton. proper diagnosis is key. Too often doctors throw out terms like “metatarsalgia”, “capsulitis”, tendonitis”, “tenosynovitis” without ever addressing what is causing the “itis” or “algia” in the first place! I also see a Morton’s Neuroma diagnosed…..way too often without an MRI when in fact the person has a plantar plate tear that is worsening. This is also the case in Bone Marrow Edema….why is the bone inflammed and bruised? Probably because of excess repetitive strain on the bone! If you would like to schedule a phone consultation you can by calling 858-268-8525.

Sujeet pandey 05-10-2015, 11:35

My 12 year son, weighing about 63 kgs, height 5’1″ twisted his ankle while playing basketball and had a fracture just above his little finger in the left foot. He was in plaster for a month. Subsequently, for the past 7 months after the plaster was removed, he is under severe pain. MRI, taken twice over this period, and bone scan show edema between 3rd and 4th metatersal. One doctor says he has stress fracture, while the other says its bone edema. He is taking two medicines namely gabapen and nervup for the past one month and wears a shoe especially designed for stress fracture. But there is no relief.

Pl advise what to do, which medicines to take, what exercises to do?
Regards
Sujeet

Dr. Runco 06-10-2015, 16:37

no exercises for stress features. You stated that the edema was “between the 3rd and 4th metatarsals”. This is different than being “in the 3rd and 4th metatarsals” Can you tell me EXACTLY what the MRI reads?
It also sounds like you are telling me he fractured his 5th metatarsal….did he have pain in the 3rd or 4th metatarsal prior to the cast and boot?

britt 26-12-2015, 00:04

Hi Dr. Runco,
I have questions regarding MRI results for my daughter. Are you are still answering questions on this thread?

Dr. Runco 27-12-2015, 05:18

Hi Britt,
What can I answer for you. If you like email me a copy of the MRI report at DrRunco@sdri.net

Juergen 03-01-2016, 12:37

Dear Dr. Runco,
I’ve been diagnosed moderate bone marrow edema in the base of the 2nd metatarsal bone. Also, the tissue around the bone is affected, according to the radiologist’s report (MRI picture was made one week ago). I’m a runner and since March 2015 started wearing minimalist shoes only (these barefoot glovelike shoes). I think, over time, I developed a stress reaction because of poor running form. 1st slight pain occurred 4 months ago, two weeks ago it was more painful, so I finally consulted a doctor. I should have learned to run barefoot properly before using these shoes. That’s just my theory. What I’m worried about: The orthopedist/doc said I just needed to rest, however, it could take up to a year to heal. I did not get any boot. I’m concerned healing might take unnecessary long, because of not using a boot. My internet searches let me believe, a boot is imperative. What do you think? Regards, Juergen

Dr. Runco 04-01-2016, 09:15

you need to go into a boot immediately. There are also many other things that can be tried to increase the healing response and help you recover more quickly. If you would like more information please email me directly at DrRunco@sdri.net

Allison 14-01-2016, 17:39

Dear Dr. Runco,
I’m so glad to see this page and hope you can help me better understand my situation. I am 46 y/o female with hx Osteopenia. On 7/27/15 I fell and fractured my left cuboid, 4th and 5th metatarsals and lateral malleolus. I was in a cast for about 6 weeks then a CAM walker for a month or so then PT 2x/week. Looking at my xrays, I am able to see the healing of the 4th metatarsal but, I don’t see significant healing in 5th metatarsal. Dr says it is healed. I just had an MRI ankle for continued pain around/ under my ankle and the PA said results were ok. No OCD tear, cuboid shows good healing. Impression: Probable contusion within tip of Lateral Malleolus. Type 2 accessory navicular with faint edema as it articulates within the tarsonavicular. In the Findings section is says there is marrow edema within inferior tip of lateral malleolus. I have the MRI study on disc and there is an image of what I think is the 5th metatarsal and it looks like there is a gap that does not belong there. I’ve messaged the PA to see if the MRI could be reviewed in that area. (no mention of metatarsals on written report, I’m assuming because the order was to r/o OCD tear) I have complained of pain that radiates up my outer leg with prolonged weight bearing for past 3 monthly visits. I just know that it doesn’t feel right.Is it time for a second opinion? Thank you for your time. Regards, Allison

Dr. Runco 14-01-2016, 17:44

5th metatarsals are notorious for non-union fracture healing and often require surgery to pin it. Stop talking to the PA and talk to another orthopedic

Ken 20-01-2016, 13:52

Dear Dr. Runco.

I suffered an eversion sprain 14 months ago when I stepped on a rock while jogging. The pain was quite intense. X-rays were negative. I was in an air cast for a few months. To this day, if I’m barefoot or on my feet more than an hour, the ankle gets very sore. I rolled my ankle many times laterally as a kid but nothing really lingered like this.
I went to a orthopaedic surgeon a few weeks ago. The MRI showed I had lateral ligament damage and “edmema-like signal alteration inferior tip of the medial malleolus and adjacent attachment of deltoid.” I am scheduled to have Brostrom-Gould Procedure next week.

My understanding is this addresses the lateral damage but not my eversion sprain issues. I’m concerned my current pain won’t be addressed at all. Your thoughts?

Thanks! Ken

Dr. Runco 20-01-2016, 15:45

where is your pain? Medial ankle? lateral? Both?

Ken Chmelko 21-01-2016, 05:45

My pain is medial. It’s just somewhat weak lateral.

Tonya 21-01-2016, 08:07

My husband unloads trucks for frito lay. They loaded his truck on a straight frame trailer for some reason. (Apparently someone didn’t know what they were doing). Because it was loaded on the wrong trailer, he had to walk up a steep inclined 200+ times. He has over 2000 cases. He was very sore the next day which he expected to be. He had a lot of pain in his hip but he thought it would work its self out. It did not. It continued to get worse and almost unbearable. He went to urgent care and they said he probably pulled something and gave him a steroid shot. He continued to work thru it and Saturday he went back to urgent care because it was much worse. They gave him an anti-inflammatory shot, muscle relaxers and steroid pills. Monday he wasn’t any better and turned It in at work. They sent him to the company dr. And he ordered a MRI. Three hours later, (which is almost unheard of) they called him with the results. They said he had transient bone marrow oedema and a hip fracture. They are saying it’s not workmans comp because of the edema. My question is, could the fracture cause the edema? He has never had any hip pain before. We are stressing out, he is the only one working, I am a stay at home mom. It seems to me they are just trying to get out of paying workmans comp. By the way it has been approximately six weeks since the initial incident.

Dr. Runco 21-01-2016, 12:14

if it happened during the course of his work day…or even going to and from work then it is work comp. This is probably going to be a very saddening and eye opening experience for you unfortunately. I would advise you get a work comp attorney. The notion that a work injury could cause a stress fracture and not bone marrow edema is laughable and ridiculous.

Dr. Runco 21-01-2016, 12:16

The MRI shows you may have deltoid ligament damage. It could also be that the medial malleolus is simply bruised…..ask the orthopod doing the surgery why he will not inspect the area during your surgery. If there is damage he can fix both

Megan 27-01-2016, 18:10

I am an avid, competitive runner. I developed pin point pain right on my 5th metatarsal. I could no longer run because I had pain on the lateral portion of my foot. The doctor suspected a stress fracture, put me in a boot and sent me for an MRI. I got the report back and meet the doctor tomorrow. I have been in the boot a week and a half and I still have the pain right on the bone so no improvement yet. I want to be prepared to talk with the doctor. The report reads:

Findings: There is mild muscular edema involving the abductor DJD minimi muscle along the lateral aspect of the 5th metatarsal. Fairly nonspecific, likely muscular strain. Marrow signal is normal. There is no evidence of fracture or avascular necrosis. No tenosynovitis

There is mild bony spurring at the 1st metatarsal-phalangeal joints and in the sesamoids consistent with mild degenerative change.

Limited visualization of the plantar fascia is unremarkable. Limited visualization of the mid foot is unremarkable.

Impression: There is mild muscular edema involving the abductor digiti minimi muscle along the lateral aspect of the 5th metatarsal. Fairly nonspecific. Question muscular strain/bruise. No bony acute abnormality is seen.

Muscular strain??? Really?? I’m not impressed with this report.

Dr. Runco 28-01-2016, 04:45

Hi Megan,
Regarding the MRI report…..strain of the abductor digiti minimi is not a normal running injury. It is possible the report is accurate though and you strained it doing something else. It is also possible that the MRI is inaccurate or the person reading the report made a mistake. Either way the MRI is not going to solve your issue as it is diagnostic and not therapeutic. So lets imagine the MRI report is accurate. At least you do not have a fracture and your injury should heal rather quickly, within 1-3 weeks. It is also not a traditional running injury so perhaps you can run sooner. Now lets imagine the MRI is incorrect and missed your true injury which on the 5th metatarsal could be a stress fracture, bone marrow edema or insertional peroneal tendonitis. In this case the bone injuries would take about 6 weeks to heal and the peroneal tendon 3-4 weeks….with no running. In any case if it hurts to run and gets worse than you should not run…..no matter what the injury is. If you choose to run and the pain gets worse eventually you will stop anyway and most likely not be able to run for a longer period of time. In any case a boot is an overreaction though and is not necessary. There also may be some modifications that could be temporarily done to your shoe insert to support the lateral foot/5th metatarsal area and reduce the pain which might allow you to run. If you were in my clinic I would stress test you on our antigravity treadmill (alterG) to see if I could make the pain go away while you ran at a lighter body weight. I would also try the shoe insert modification. My guess is your doctor will do neither of these. If you are in the San Diego area and would like my help email me directly at DrRunco@sdri.net or call 858-268-8525

Kylie 31-01-2016, 08:50

After giving birth, I started running again. I was not wearing supportive shoes and was running on gravel. Afterward I had a slight twinge in my heel that progressively got worse and worse. I started seeing a chiropractor and he thought I had plantar faciitis, then I started seeing a podiatrist and he took x rays and it showed plantar faciitis and flat feet in both feet. I started physical therapy 3x a week and the ultrasound machine hurt me terribly. After 2 weeks of PT I went back to the podiatrist and he put me in a walking boot. He also did the tuning fork on me and it was very painful in my right foot, just vibrations in my left. The walking boot still was incredibly painful so I went to my family doctor who scheduled an MRI in the right foot. It came back as bone marrow edema and she told me to be completely non weight bearing and on crutches for six weeks. I am focusing on rest and icing both feet because my “good foot” is now acting horrible as well. I believe it could be from overuse but I am not 100% sure. My feet are both swollen and it has been 6 months now since the initial injury. What else can I do to speed up this process? It’s been a huge challenge trying to keep up with my small children as I am in such agony with both feet. Thank you!

Dr. Runco 05-02-2016, 16:09

Kylie it is unusual to hear that after 6 months you are still in pain…..it implies that things that have been done have been making it worse thus preventing you from recovery. You say the podiatrist took x-rays that showed plantar fasciitis……x-rays can not shoe plantar fasciitis they only show bone not tissue. The MRI showed bone marrow edema…..not plantar fasciitis and you were put on crutches for 6 weeks? And it did not get better? You also say that now your “good foot” is acting horribly and that it could be from overuse? How would that be possible if you were on crutches? I want to help but need to understand a bit more. If you could email me directly with more details, a copy of the x-ray report and MRI report I can help you Drrunco@sdri.net

Kristi 17-02-2016, 18:51

My 14 y/o son had severe pain to both heels and both lateral aspects of the feet last year during baseball season. This was his first season to wear steel cleats with hard bottoms and his feet were growing very fast. Went to pediatrician and they said it was growing pains and possibly the steel cleats so we got new cleats but the left lateral foot continued to hurt for about 2 months. Over the past year he has went from a size 9.5 to a 13 in mens. His foot got caught under a car rolling. The xrays were normal with no fractures but the doctor was concern about the 5th metatarsal where he was hurting last year. Due to the accident that they sent us to an orthopedic close by to have them to assess the xray due to the 5th metatarsal. He was walking on foot with some pain but no change in gait due to pain. The orthopedic doctor and he ordered MRI to rule out a lisfranc ligament tear due to his pain being in the mid foot area and put him in a walking boot and they stated that the 5th metatarsal is an old injury that is healing. He has had no pain since that day. He started walking in the house without the boot without any problems.
MRI impression
1. No acute bone abnormality, tendinopathy, or ligament tear with lisfranc ligament is intact
2. Multiple growth plates remain open, increased T2 weighted bone marrow signal adjacent to the proximal fifth metatarsal physics suggest mechanical instability or contusion.

I’m just wondering if I need to make an appt with another orthopedic doctor due to the fifth metatarsal even though it is an old injury. He was not our first choice and was just sent there because he was close by.

Thank you

Dr. Runco 18-02-2016, 08:40

The MRI appears normal….if he has no pain why see another doctor?

Karishma Kaul 03-03-2016, 09:59

Hi Doc! I have been running for several years and but stated doing interval and tempo training only on the last one year. Since Dec 15, I felt my left lower leg was increasingly being sore after speed workouts. In the first week of Jan 16, I started to get pain in my shin and my orthopaedic believed it was shin splint and put me on a physiotherapy for the same. They made me run short 2-5k distances to check the threshold of the pain. Initially, after running about 300mts, I wouldn’t feel the pain much. However, the intensity of the pain increased over time and has now reached a point where the pain doesn’t get better even after running 2k. The doc finally thought I was had a stress fracture. I got the MRI done and it reads as follows :
1. Focal marrow edema in mid shaft of left tibia; 2. Mild adjacent periosteal edema along anteromedial aspect of mid shaft of tibia; 3. Mild subcutaneous edema also seem ; 4. Muscle of leg appears normal, no intramuscular edema seen.
I wanted to check with you what could have caused this and what measures should I now take to ensure proper healing? How soon can I get back to running? Can I do cross training including cycling, rowing or elliptical until I can start running again.

Thanks in advance.

Regards,
Karishma

Gowri 10-03-2016, 21:52

Hi Doctor,
i have left ankle from past 1 year.I had twisted my left ankle while stepping down in stairs.In initial diagnosis, doctor said nothing wrong in xray, but i used to get pain in left leg once in a while, doctor gave me tablets. i am trying for my pregnancy ,now i feel the pain is more, so i took MRI scan yesterday, attached is the report.
i am worried about my pregnancy because of this. i am not pregnant still.
3T MRI LEFT ANKLE
PROTOCOL:
Axial T1, T2 Wt and STIR sequences
Coronal T2 Wt and sagittal STIR sequences
OBSERVATIONS:
Grade I sprain of anterior talo-fibular ligament is noted with periligamentous oedema.
Attachments are intact.
Rest of the ligaments are normal.
Mild marrow oedema is noted involving head of 2
nd
and 3
rd
metatarsal bones.
Tibial and fibular shafts appear normal in the visualised sections.
Medial and lateral malleoli are normal. No evidence of abnormal signal changes.
Os navicular is noted.
Tarsal bones are normal. No evidence of abnormal marrow signal changes.
Minimal intrasubstance degeneration is noted in the tendo-achilles.
Attachments are intact.
Flexor and extensor groups of tendons are normal.
Plantar fascia is normal.
Minimal tibio-talar and subtalar joint effusion is noted.
Impression:
Grade I sprain of anterior talo-fibular ligament with periligamentous oedema.

Mild marrow oedema involving head of 2ndand 3rdmetatarsal bones

Robert Melson 11-03-2016, 15:02

Dr. Runco, I came across this website while searching bone edema.
I am a long distance runner who has been struggling for almost two years to recover from what I believe are three injuries. Two of which have been diagnosed. Sesamoiditis confirmed by MRI as bone marrow edema in the distal tibial sesamoid (bipartite) and Superficial plantar fibramatosis and sometimes severe ankle pain located near rear of the heal under the peroneal tendon as it wraps around the ankle bone. This ankle pain was diagnosed as excess scar tissue resulting from a sprain, but it has not been accurately diagnosed. My doctor has offered, after a year to remove the sesamoid bone, as well as to scope the ankle and remove the tissue. In this appointment I asked does this still have a chance to heal on its own? His answer was yes. The fibramatosis is apparently has no treatment besides a compound topical I was prescribed to kill pain, which partially works, but night splinting seems to work just as well. After months and months of rehab, am PT work my problems persist. Now to the point that I’m considering getting the sesamoid bone removed, ankle scoped and a shot of cortisone in my plantar fibroma to shrink it all at the same time. I’m having trouble with this decision because the idea of being so invasive is hard to deal with. I used to run marathons and ultra marathons, skiing, rock climb and mountaineering. I miss doing these activities and more than anything want to return to some pain free living. However every time I slowly start training, these problems come raging back after months of impact free activities and physical therapy. I’ve been to a surgeon, chiropractor, physical therapist, message, acupuncture and tried countless other things. Frankly I’m at a loss. I’ve been considering just begging the doctor to cast my ankle and foot for six weeks just to see what would happen. If there are any words of advice or things that I should consider before embarking on any more invasive treatments? I appreciate any thoughts and thank you for your time.
Robert Nelson

vivian teemsma 14-03-2016, 06:28

Good Morning: I am 53 yrs old, in August 2015 after months of feeling pain on top of left foot I went to Podiatry Office to be told that I had a stress fracture. Now eight months later pain still there went for two more MRI’s and was told that they found faint marrow edema throughout multiple bones of the hindfoot and midfoot compatible stress reaction. There are small nondisplaced trabecular stress fractures at the base of the third metatarsal and more prominent stress reaction along the calcaneal side of the posterior subtalar joint. The previous medial cuneiform fracture has healed. . Diffuse intramuscular edema, most notably within the flexor halluces muscle above the level the ankle joint. Finding may be seen in the setting of low-grade muscle strain or denervation.
ICD 10- Fracture 3rd Metatarsal Non Displaced (MSK Foot Left. )

After the Orthopedic Doctor found out results stated that he was stumped and wants me to see another Podiatrist. I am now waiting for an appointment, but this is my fifth Dr. and after being on crutches for this long and no one seems to know why this is happening and why I am in pain every minute of the day. I feel like I have been getting the run around from Doctors and am looking to find a Dr. that knows what could be the cause. I realize that you are in another State but my Daughter found your site and thought that maybe you could help me figure out what is going on and maybe have a Doctor in the area where I live that you could recommend me to. I live in Suffolk County in New York.

I thank you for your time, and look forward to hearing your thoughts.

Sincerely
Vivian Teemsma

Kaitlyn 26-03-2016, 22:03

I’m realIy hoping you might have an idea about what might be wrong with me. I have a complicated case and doctors keep telling me that they don’t know what is wrong and that they can’t do anything for me. A year and a half ago I rolled one of my ankles while running and my pain was so bad I couldn’t walk. I ended up getting an MRI and I found out I had bilateral tarsal coalitions. It was the calcaneous and navicular bones and it was fibrous coalitions. I was on crutches for about six months and a month of that I was in casts. My first specialist thought that my pain wasn’t from the coalition and was just trying to be conservative as possible. I ended up getting referred to a different specialist and had two surgeries to resect them both and was in casts and on crutches for about 2 more months. After the first surgery I had significantly less pain but when I had surgery on my other foot it caused my first foot to have a lot of inflammation at the surgery site. I was having a really hard time walking at that point and I had a cortisone shot. It stopped the pain for a short time before I started having significant pain again. My doctors and physical therapists think it is tendonitis of the peroneus brevis but I am having a hard time believing it is. They have even said that is doesn’t respond to any treatment like it is supposed to. They have tried putting in a boot several times but it just caused it to flare up to the point I can’t walk. We have tried custom inserts, new shoes and evaluating my walk but I am still in a lot of pain. Any time I put a shoe on my pain level goes up about 2 or 3. They had me try another cortisone shot but it lasted maybe five days on the forth day i could tell it was getting worse. I am in so much pain now that I am on crutches again. Going up on my toes makes it hurt significantly. It hurts if it is pressed on near the cuboid and fifth metatarsal. On really bad days when I have had to walk a lot, it hurts to have anything touch it. It only hurts in that spot, occasionally I have had pain on the bottom on that side of the foot but that is it. They want to check for stress fractures now but if that comes back fine, I was told that they can’t do anything and that I just have to hope it gets better. I got an MRI last week but I haven’t heard what the report says. I am supposed to be running college level r but I really just want to be able to walk pain free.

Dr. Runco 28-03-2016, 14:36

Kaitlyn I am sorry you have to deal with this. I would like to help you. Please take a picture of your foot and mark the painful area. Email it to drrunco@sdri.net.
Also email me copies of any and all X-ray or MRI reports that you have. I do not need the actual images yet just the reports will suffice.
Take pictures and email any braces, orthotics etc that you have used.
After I review everything I will tell you the next step. Where do you live?

Dr. Runco 28-03-2016, 15:54

Vivian where exactly is your pain? if you mark the painful spot take a picture and email it to me at drrunco@sdri.net as well as pictures/copies of your MRI reports I can advise you better.

Dr. Runco 28-03-2016, 15:57

Robert do you have an MRI report? If so take a picture and email it to me drrunco@sdri.net
sesamoiditis can be tricky but I get good ……very good results with using a specific “dancers pad”
In 17 years of practice I have only sent 2 patients to have their sesamoid removed.
The plantar fasciosis/fibromatosis is easy to fix….casting will not help in fact it would probably make it worse.
As far as the lateral injury you described….it could be a compensation injury….mark the painful spot, take a picture and email it to me

Dr. Runco 28-03-2016, 16:39

I am not really sure what you are asking of me Gowri. Your MRI does show a sprain…which is consistent with your description of your injury…..and will not interfere with your getting pregnant.

Dr. Runco 28-03-2016, 16:41

marrow edema is treated in the same way as a stress fracture…no running………..no impact for 6-8 weeks.
Stress fractures occur because of too much repetitive impact without enough recovery time.
Non impact activities while you are healing such as cycling, rowing and elliptical should be fine

Paula 14-04-2016, 15:37

Hi! I’m 41 and was diagnosed with plantars fasciitis Iin my left foot in 2013. The pain has steadily become worse and is now in both feet. The only time they don’t hurt is when I’m not up and walking around. Sooo back to the podiatrist I go and an MRI scheduled. The results are as follows
Right foot-
– Tear of the Plantar plate
-strained Flexor hallucis brevis
-effusion in the 1st metatarsal joint with loss of cartilage and focal thinning of cortex
-mild spur formation

Left foot
– prominent plantar fasciitis / partial interstitial tearing
-moderate edema in fat pad
-subchondral marrow edema in the plantar calcaneus w /large plantar calcaneal ensthesophyte

Can you explain all this and what treatment options may be as I cannot get into my dr for a few more weeks

Dr. Runco 20-04-2016, 09:41

you have two different injuries with the right foot being more severe. You are going to need a high level of management too overcome these injuries without surgery but you can overcome them.
What are you currently doing about it? Are you doing any home treatments? You are going to need to go non-weight bearing for at least 6-8 weeks for the right foot…..the left well..you have a heel spur and their are ways to overcome that as well.
If you would like expert and further help with this please email me directly, copy and paste your comments to me as well as provide a chronological history of your condition and I will be happy to provide you with more information. Drrunco@sdri.net

Erika 21-04-2016, 19:23

I was diagnosed with bone marrow edema 2 months ago.
I have been in a boot (air cast) and have been on limited to no walking. I was Told by my doctor that it could take up to 8-12 months for my foot to heal. As in, I will be in the air cast for 8-12 months. Not ideal for a stay at home mom with 2 little children. Is this time frame accurate? Is surgery possible? I’m only 2 months in and I’m going nuts! 🙄

Dr. Runco 21-04-2016, 19:36

what bone is the edema in? Do you have a copy of the MRI report? You can take a picture of it and send it to me at Drrunco@sdri.net

Marianna 15-05-2016, 13:24

My husband felt sharp pain after jogging and was diagnosed with stress fracture in the 3rd-4th toe meditarsal area of his right foot in February. He’s been wearing a boot since. The pain on top of his foot has not got significantly better and X rays have not shown any signs of bone healing. He was recommended a bone growth stimulator, and recently requested an MRI.
MRI results are from 4/28 as follow:
Short axis images show no significant tenosynovial effusion. The long axis images show mild first metatarsophalangeal degenarative change. The Lisfranc ligament and Lisfranc articulation appear intact. No focal bone contusion or marrow edema is seen to indicate stress fracture or postraumatic change. No prominent cyst formation appreciated. Short axis images show no significant soft tissue edema. No tenosynovitis is seen in the imaged portions of the plantar fascia show no focal deformity.

No lobular fluid signal intensity or ganglion cyst is currently identified in the region of the third/forth metatarsal base. No periarticular mass or ganglion and no bony erosion or cortical destruction is identified.

Impression:
mild degenerative change the first metatarsophalangeal articulation. otherwise, no significant focal deformity acute bony abnormality.

What are your recommendations? Thanks.

Judy 19-05-2016, 14:31

Hello Dr,
Leading up to December 2015 I had plantar fasciitis in my right foot which caused me to limp. By the end of January I could barely walk. The only way I was able to walk at all on my own was to use the inside of my left foot. I saw an orthopedist for the pain in my left foot but he was more concerned with what was going on with my right foot even though I knew it was plantar fasciitis in my right foot he prescribed an MRI of my right foot. That showed plantar fasciitis. I asked what was wrong with my left foot and he said tendinitis. I asked what I could do for it and he told me to elevate it and ice it and wean myself off the crutches. He said it would take 3-4 weeks to resolve. I went to another orthopedist March 22, 2016 who put me in a cast for 4 weeks. When the case came off my foot was VERY swollen. She also diagnosed tendinitis without ordering an MRI. Finally in April I got an MRI of my left foot. Here are the results of my MRI.

Fairly extensive bone marrow edema noted along the proximal aspect of the middle and lateral cuneiform bones and patchy marrow edema throughout the cuboid bone. There is also prominent marrow edema in the head of the talus. There are no definite associated fracture lines. The findings most likely represent stress reaction.

The syndesmotic ligaments are intact.

The anterior and posterior talofibular ligaments are intact. The calcaneofibular ligament appears intact.

The deltoid ligament is intact.

The extensor and peroneal tendons are normal in thickness and signal. There is a slight relative degree of enlargement of the posterior tibial tendon with respect to the remaining flexor tendons suggestive of a very mild degreee of posterior tibialis tendinopathy but no abnormal signal and no evidence of a posterior tibialis tendon tear. The remaining flexor tendons are within normal limits.

The Achilles tendon is normal in thickness and signal and intact. Trace retrocalaneal bursitis is noted.

There is a small tibiotalar joint effusion. The tibiotalar and subalar joints are otherwise normal. A mild degree of productive osteoarthritis of the talonavicular joint is noted.

Nonspecific diffuse subcutaneous edema is present, especially along the lateral aspect of the ankle and foot with a more mild degree of edema along the medial aspects. There is diffuse edema within the distal calf muscles as well but no evidence of muscle hemorrhage.

A small plantar calcaneal spur is noted.

Impression:
1. Extensive patchy bone marrow edema present within the bones of the midfoot and navicular head without any associated fracture lines. Pattern suggests this is probably due to stress reaction.
1 Mimimal degree of abnormal thickening in the posterior tibialis tendon noted consistent with slight tendinopathy.
3. No evidence of plantar fasciitis .
4. Extensive nonspecific subcutaneous edema most prominent along the lateral aspect of the ankle.

I was prescribed a bone stimulator but it was denied by the insurance company. I hope you can give me some advise as to where to turn next. Thank you for your time.

Sabrina 28-05-2016, 15:36

I fell down a step 6.5 weeks ago and rolled my ankle, had two X-rays which were clear but no improvement in pain, I had mri today but will have to wait a week for report, I got the disk, how would I see a fracture on the disk

Dr. Runco 01-06-2016, 13:45

They gave you the disc so that you may consult with a specialist regarding your condition and provide them with an expert image. Unfortunately I do not have the capability to instruct you via online on how to read x-rays. I could suggest you go to google images and google “ankle fracture” and compare your films to it. Most likely you do not have a fracture but a sprain = tron ligament. This will take months to completely heal and you can not see it on x-ray

Dr. Runco 01-06-2016, 14:02

Based on your extensive description and MRI results I can only guess that the heel spur noted by the radiologist is the cause of the problem.
There insinuation that you have a stress fracture is inconsistent with your history so I think that is probably a misread.
Where is your pain? In the heel? Arch? After I get a little more information I should be able to help you.

Dr. Runco 01-06-2016, 14:05

This is what I recommend as it is obvious he was misdiagnosed with a fracture.
Take a picture of his feet while looking down at them while sitting and then again standing…email me those drrunco@sdri.net
mark the painful spot and email me that picture.
Also copy and paste your original email to me as well. After I see these i will contact you and should be able to help

Marie 02-06-2016, 05:19

My 10 year old daughter landed awkwardly from a jump of a half metre height 4 weeks ago. She has had two negative X-rays but continued to have pain. She has been non-weight bearing in a boot and crutches for the last 10 days after an MRI showed reactive bone marrow oedema at the base of the 4th metatarsal and bone bruising involving the lateral cuneiform. How long should she stay in boot and on crutches?

Dr. Runco 13-06-2016, 16:07

bone marrow edema or bone bruising will typically take as long to heal as a fracture would. Unless your doctor is giving you some unusual advice it sounds like you are near the 6 week mark since the injury and she should be turning the corner. Of course she could have other issues such as a bone-joint subluxation on top of the bruising

David 20-06-2016, 14:41

Hi Dr. Runco–

I had been running 50+ miles/week in 2016, and 2500+ miles in 2015. I’ve had pain in my big toe since April 2016. In May, my doc sent me to get an x-ray which concluded “Hallux valgus at the first MTP joint without evidence of fracture or dislocation.” She sent me to a podiatrist to get orthotics.

The podiatrist had me get an MRI, which concluded: “1. Nondisplaced medial sesamoid fracture.” and “2. Extensive marrow edema and cystic changes seen within the lateral aspect of the first metatarsal head at its articulation with the lateral sesamoid. The lateral sesamoid has decreased signal intensity on T1 suggesting underlying sclerosis.”

I’m in a boot for four weeks, and then the podiatrist is going to have me get another x-ray to reassess.

My questions: is an x-ray in four weeks going to actually show if the bone marrow edema / broken sesamoid are healed? Is four weeks enough time in a boot? Should I also refrain from biking and swimming? Will electrical bone stimulation help in the recovery?

Thanks so much for your help!

Dr. Runco 22-06-2016, 04:49

I doubt the 4 weeks will be enough time. X-rays will not sow bone marrow edema but may show if the fractured sesamoid is healed. In my experience it is more likely you have a bipartite sesamoid and it is not actually fractured.

Dr. Runco 22-06-2016, 04:52

that is hard to say but typically bone marrow edema takes as long as a fracture does to heal. She should be retested at 4 weeks, 6 weeks and 8 weeks. Make sure she is getting what she needs nutritionally to help the bones heal

Bonnie Baker Goodman 29-06-2016, 03:52

I had groin pain radiating down leg, August 2015 while doing my 3mi walk. Recovered, but occasionally pain came back.Finally settling in my left heel.Xray dx was edema plantar heel. Two rounds of antibiotics..Aleve treatment.Pain constant..Bought KURUs .helping . But after am exercise of any sort pain rest of day..no mri done .got a night splint- too early to tell. Diabetes Type 2 since 2005.

Dr. Runco 29-06-2016, 05:02

I would not normally associate groin pain radiating down your leg with heel pain…..nor would I associate taking anti biotics with heel pain. I ma also not sure why KURU shoes would help but perhaps they somehow offload your heel. You never really asked a question so I do not know how to respond but it sounds like you might be struggling with plantar fasciits. Keep using the night splint, Let me know if you have any questions.

nav 30-06-2016, 03:51

Hi Dr. Runco–

I have a severe pain in my left heal from last 3 to 4 years and i have a standing job. my pain is on peak when i walk after resting.

I have been to couple of docs, too local steroid twice in my heal but it was just a temporary solution for it. some doctor suggested me stretching and calf strengthening exercise but nothing helped. The pain is becoming worse day by day. it has become a barrier for me to live my life how i want to.
currently I am doing a Ayurveda treatment in which i apply oil to my heal and then heat it in mud for 20 – 30 mins daily before bed time from last 20 days. slight temporary relief with it but pain is still as it is.

below is my MRI report. Request you to let me know what you think about it.

MRI Report:
Small Focal area of marrow edema notedin postero-inferior aspect of calcaneum.
Minimal soft tissue edema. No evidence of any collection or lesion in the calcaneum.

Thank you for your time.
Nav.

Dr. Runco 30-06-2016, 09:49

The MRI shows bone marrow edema. This should not be causing you the type of pain and the duration you describe. Do you have any other conditions such as Diabetes or some other type of autoimmune condition?

Darshana patel 27-07-2016, 12:29

i started with swelling lateral of my left foot right behind the ankle.then I started having trobbing pain,My podiatrist did ultrasound and told me I have tendon tear. two wek I was doing good but my pain became so intense on top of my foot,right behind my ankle and started feeling something is moving.
I had MRI done which shows Evidence of a well corticated interosseous cystic lesion noted with in the neutral triangle of the calcaneus with evidence of communication to the sinus tarsi.the lesion does not appears to be expansible though there is some mild reactive marrow edema with in adjacent tissue.there is no evidence of pathologic fracture noted.
2.Both peroneus and brevis tendons of lateral left ankle appears to be longitudinally intact and unremarkable in study.no teras and tendinopathy

please send me reply what to do?can I walk?its been going on now 7 weeks.now I am using crutches to walk.i have this very typical burning pain on top of my foot and lateral side of my my foot..

darshana 27-07-2016, 12:36

I forgot to mention that I have pain in my rt foot back of my ankle.

Dr. Runco 27-07-2016, 12:44

If the cyst is the problem you will need it surgically removed. What does your doctor tell you to do?

Dr. Runco 27-07-2016, 12:44

what is your doctor telling you to do? Keep in mind their original diagnosis was incorrect. In my opinion that cyst needs to be removed….unless I am missing something

Pamela Zeller 29-07-2016, 19:47

My 21 year old son had a new boxed treadmill fall off of a dolly and land on the top of his foot. It has been xrayed twice which showed nothing and then an MRI come out negative and has now pretty much been told there is nothing wrong with his foot. He cannot walk flat foot and walks with a lime putting most of the weight on the outside of his foot and uses a cane.. It is painful to the touch, and has been told he can go back to work with no restrictions. What could the MRI have missed that could be causing such pain.

Dr. Runco 30-07-2016, 05:03

Pamela I would need more information to even begin to help your son.
1. send me a copy of the MRI report.
2. take a picture of his foot, mark the painful spot and send me that
3. send me a chronological list of what has been done thus far from the time of injury to present

Dave Cartmell 08-08-2016, 05:38

I had an MRI and it was determined that I have edema within the third metatarsal head propagating into the neck and mid-diaphysis. In addition, I have some mild periosteal edema extending into the interosseous muscles. Part of my recovery plan prescribed by my podiatrist is a sport orthotic and will be getting that custom item in a week or two. I am also to stop running for 6 weeks. My question is, what can I do while this is condition heals? Is it okay to do elliptical, cycle, etc.? BTW: I have had this problem off-and-on for 10 to 15 years. The pain associated becomes more noticeable only after weight bearing for 1-hour or longer, standing or running. During the Boston Marathon the pain occurred around mile 13 (1:45 time) and was excruciating until finished.

Dr. Runco 08-08-2016, 13:45

Hopefully the insoles will help your condition from coming back Dave. Until its healed exercises that do not aggravate your foot are OK to do….whatever that might be. If elliptical does not hurt do it. Cycling should definitely not hurt so that is OK to

Patricia Henderson 20-08-2016, 20:24

I found your website when I started researching bone marrow edema. I am not a runner. I am a 65 year old woman with a neurological disease called Hereditary Spastic Paraplegia which is basically characterized by really weak leg muscles. I have been in excruciating pain for years with my foot to the point that no one knows what to do. I know you’re in California. I am in Delaware. I just had an MRI of my left ankle done which shows increased bone marrow edema from my last one 3 years ago. I was wondering if there is a way that i could snd you my MRIs and background because it is very long and involved and I basically have no hope and don’t know what to do. I can’t wear a boot (even though my Podiatrist didn’t suggest it,) because I don’t have the strength to lift up the weight of it due to my disease. I have been to numerous podiatrists and tried what they suggest cortisone shots, laser treatments, physical therapy, acupuncture. Now seeing a pain mgmt specialist and the pain still can’t be controlled. My situation is to involved to explain here but I could writing out a history and send you all my test results and see what you think. I am basically at my wits end. I worked 44 years and retired and probably spend 20 hours a day in bed. It’s a terrible way to live. Will you review my information?

Dr. Runco 22-08-2016, 14:34

I am sorry to heart about your troubles. You can send all of your information to
San Diego Running Institute
Attn: Dr. Victor Runco
8525 Gibbs Drive Suite 205
San Diego, CA 92123

The cost for the consultation is $150. I can have my office send you a secure invoice. You can email me directly at drrunco@sdri.net

Jason Novoshelski 25-08-2016, 05:19

Hi Doc, My son Jake is a 14 year old academy soccer player. He has been training/playing since he was 5. The amount of training/ playing that they do is crazy. He has Hallus Limitus in both big toes and has had many stress fractures on the smaller toes and shafts down the line. Recent mri confirmed Plantar Plate tear of 3rd metatarsal as well as stress reaction to 3rd and 4th toes confirmed by fluid in the bone. After he is healed, Doctor says orthotics will help this out because the Hallus Limitus makes his foot strike the ground in a way that puts a lot of pressure on his other toes. Any thoughts?

Thank you,
Jason

Dr. Runco 25-08-2016, 11:54

HI Jason, I am sorry to hear about your sons troubles at such a young age. While orthotics are appropriate considering his past history it would be critical to have the appropriate orthotics made. Making orthotics for conditions such as your sons is truly an art form and less of a science. I am guessing you do not live in San Diego but if you are I would like the chance to help your son. You can also email me directly at drrunco@sdri.net

Katrina Schabacker 09-09-2016, 11:03

Hi Dr Runco, I broke my cuboid in June 2015; we didn’t know it was broken until MRI showed it in Mid Aug; I was casted then for 6 weeks with no healing to the bone at all per CT scan at end of casting. I then saw an orthosurgeon who did ORIF in End of Oct with 5 screws and a plate. Per CT in February, 2016, cuboid healed but I started having pain on top of my foot below my 4th metatarsal with bruising and trace swelling noted. We tried a steroid shot thinking possible morton’s neuroma but no relief at all. We then had the screws removed in June 2016, but the area remains tender to touch and new bruising daily. I just had another MRI and it shows edema to the 3-4th metarsal. The surgeon said it can be a precursor to a stress fx but nothing we can do to stop it. The day-to-day pain is like a constant 2-3 ache but when palpated its a 5-6! Thanks for any insight!

Dr. Runco 09-09-2016, 11:58

Katrina unfortunately your foot has been surgically altered. Possibly the alignment is off now. You may consider over the counter insoles or custom insoles to help with alignment and/or shock absorption.

arti 13-09-2016, 04:04

Hi doctor,
I had suffered from stress fracture in year 2014;now again I am having pain in walking n running.i have done my MRI which shows marrow edema in tibia.
Last time I have been put on cast for 40 days and tab rhizophos is given for 6 months before putting me in cast.
I m not a runner but yes my job and household responsibilities require prolonged standing.my question is why I am suffering from this post pregnancy although my dexa scan is fine.
Please suggest what should I do for this now.

Dr. Runco 13-09-2016, 16:13

Have you not discussed this with your doctor(s)
Pregnancy can result in the fetus absorbing everything that you also need and cause amlapsorption issues. This could be your problem

Christina 19-09-2016, 13:24

Doctor,

My son who is 11 has been experiencing heel pain since March of 2016. IT seems to be aggravated during soccer, but is present playing basketball and tennis as well. About 6 weeks ago he was told by the doctor that he has calcaneal apophysitis and his chiropractor also stated that his ankle turns in (cannot recall the technical term) when he stands, which requires him to wear orthothics. So we got him custom made orthothics and the pain continued to persist. We took an xray and everything looked good. We took him to a podiatrist and he mentioned that he should not be walking barefoot and supplied him with sandals and a higher arch of orthothics. Pain still persisted so they have him in a boot now. He has not played sports for 6 weeks now as he was told to rest. As the pain did not stop, we finally got an MRI. The MRI showed mild marrow edema. So he was requested to rest another 4-6 weeks. He finally seemed to turn a corner after taking whole food nutrients of ligaplex I and ostrophin PMG given this diagnosis. Of course during this time he has been icing and stretching as well. My questions are how long will he take to heal? When can he resume sports? Will he continue to have heel pain once he goes back? And should he take a gradual approach to playing given he will be coming off of this issue? In other words should his playing time be limited in the beginning. He plays both basketball and soccer. Thank you!

Dr. Runco 19-09-2016, 13:30

HI Christina,
Recovery and Recurrence
One of the most important things to know about Sever’s disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away.

Although Sever’s disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child’s growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.

If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever’s disease, the doctor might recommend special shoe inserts, called orthotic devices, such as:

heel pads that cushion the heel as it strikes the ground
heel lifts that reduce strain on the Achilles tendon by raising the heel
arch supports that hold the heel in an ideal position
If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel.

The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.

Kimberly Anderson 03-10-2016, 14:53

Hi Dr. Runco,

First of all I want to Thank you for serving our country. My son is Air Force , he is coming home at the end of the month, for a visit , before he deployed in January. I would love to have my foot problem resolved before he comes home, so I can enjoy our time together, before he is deployed. At the moment, I am in a lot of pain with it, and have been dealing with it for going on 2 months now. I’ve been in a cast twice, on crutches 2ith it and had injections. My podiatrist wants me to start physical therapy now, to try to get some blood flowing, in the hopes of preventing surgery?😳
I was originally diagnosed with a stress fracture to the 2 metatarsal. But after having an MRI, I was told I did not have a stress fracture of the 2nd metatarsal. I am not clear what I have, and was wondering if you could give me your opinion, based off my symptoms, and the MRI report? I would be truly grateful. Pain across the forefront bottom lad of my foot with weight and stepoff. Pain across top of my At base of toes. And pain all in big toe!

MRI findings:

Tibia and Fivulae sedan kid bones exhibit mixed high T-2 edema type signal and low signal suspicious for avascular necrosis versus possible fractures. There is marrow edema within the subjacent plantar head of the first metatarsal. There are small osteophytes at the first metatarsal phalange all joint.

2. Small fluid first, second, and third intermetatarsal bursae

3. Mild soft tissue Edna plantar ball of forefoot. Mild fibrosis in the fat lad of the forefoot plantar to the tibial sedan kid bone and Fitch metatarsal head.

Stefanie 04-10-2016, 20:03

Hi Dr. Runco! This is such an interesting read. I came across it, as I was diagnosed with a 6 mm stress fracture in my heel as well as achilles tendinitis. I believe I have tendinitis, but I’m finding it hard to believe I have a stress fracture, based on the lack of pain. About 4 weeks ago, I was forced to stop running because I could barely walk. My achilles pain was severe, especially in the morning, and it hurt to stand, run, walk or even just sit. I went to the doctor and she said she believed I had tenidinitis, and although she thought it was unlikely that I had a stress fracture, she wanted to have and MRI done, just in case. A couple days later, she called me and was shocked to find out the MRI showed a stress fracture. I was put in a boot and stopped all high impact activity for 8 days. By the 3rd or 4th day in the boot, I had absolutely no pain in my heel or achilles whatsoever. I found out about the injury 2 days before I left the country for Iceland and Paris. I did a lot of walking on my trip, in the boot of course, and I almost anticipated for my foot to ache even more, but it did not. 3 weeks later, I am able to walk and have even tried to run a little bit, and still have no pain. I’ve tried to do some research, but everything I have found on stress fractures says that it is painful through the whole healing process. How do you know when you are really healed from a stress fracture? I have a couple races coming up, and my doctor said, if I’m not in pain, I can run them, on my own accord, obviously. My follow up appointment and MRI is not until late October. I just found it really strange, as I expected a stress fracture to be much more painful. Any input would be greatly appreciated!

Thank you!

Dr. Runco 06-10-2016, 10:41

Stress fractures can heal in 4-6 weeks. It sounds like you are close to being healed. Your doctors advice is sound. If it does not hurt then go for it. I would recommend building the running up slowly and avoiding any intense workouts like sprints or hill repeats for a couple of weeks until you are sure it is better.

Dr. Runco 06-10-2016, 10:46

Kim it seems like you have been misdiagnosed and under-served by your doctor. Based on the MRI your general condition is
“Metatarsalgia” pain in the ball of the foot. In your case it seems like you have a probably plantar plate ligament tear/sprain
I am an expert in treating this and can help you via a phone consult but I also included other options below. Please let me know
how I can help you
1. New patient exam at our Sports injury clinic in Kearny Mesa, San Diego. You can call to schedule an appointment at 858-268-8525. The cost is $167 for the exam and then $69 for any necessary treatment(s) the cost of which may be covered in part or in entirety by insurance.
2. A home based therapy program. This includes a list of any necessary home therapy products you will need for rehab plus a video tutorial of me showing you step-by-step instruction of the rehabilitative stretches, strengthening exercises, massage tools, the do’s-and-dont’s of returning to physical activity and a follow up email where you can ask any follow up questions regarding your case. The cost for this is $69.
3. A phone consultation. You send me the copy of your MRI report and a chronological history of your condition, the treatments tried and any other necessary information relevant to your condition. After our phone consultation I will send you a written treatment plan with specific instructions so that you may go to a doctor or therapist of your choice to implement it. The cost for this is $167. This is not covered my insurance and you can schedule it by calling 858-268-8525.
Kim please let me know how I can best assist you and help you get rid of this painful condition.

Autumn 06-10-2016, 20:21

I was told I had a sprained ankle and foot due to a bad fall but the mri I got lastnite says I have only a fifth metatarsal phalangeal joint effusion and no other specific soft tissue damage. Yet the fall was 3 weeks ago and my ankle to my toes were black and blue. I don’t understand this. Can u explain. And it doesn’t say anything at all about a sprain or even about the bruising. I know it has almost gone away but yet it still hurts to touch and hard to stand on. Thank you

Dr. Runco 07-10-2016, 08:14

1. The MRI may not be accurate
2. The person reading the MRI may be inaccurate
bruising implies tearing and bleeding of something…muscle or ligament or tendon usually.

Ashish 13-10-2016, 08:14

Hello Dr Runco
Namaste from India. 4.5 months ago I went for trekking. 3 weeks later I had pain & reddness over top of right foot. Within days it had terrible pain that I got admitted. X-ray normal but MRI showed Patchy areas of bone marrow edema in intermediate & medial cuneiform bone,base 2nd, 3rd & 1st metatarsal bones, calcaneum antero-laterally & cuboid bone with mild surrounding soft tissue edema.Also vit D were low,ESR-25,CRP-60.My Dr started AKT-4 on suspection of bone TB, but subsequent Mantoux test& gamma radiation test came negative. Following months develop range of pain- jaw pain, swelling of left knee then right knee, back & hip pain. I referred another orthopaedic Dr who diagnosed Spondyloarthritis as HLA-B27 positive and RA factor negative. So my treatment is going wid Rheumatologist. Had both my knees aspirated. But still long dose DMARD drug, my very right foot where it all started has mild swelling on top and near ankle. I’m clueless wether my treatment is on correct track? Your input is highly appreciated.

Helen Garrett 15-10-2016, 15:25

Hi Doctor Runco I’ve been having problems with my leg sent September. I was first diagnosed with cellulitis. So my doctor prescribe me antibiotics to take. After taking them the pain was still bothering me. So I went back to my doctor then they took a MRI and that’s when they said I hade Shin Splint. Ok after going to an orthopedic doctor after looking at the MRI they said that I have Bone Marrow Edema now I have been resting the leg for about 4 weeks now. The only medication I’ve been taking is Naproxen, Ibuprofen, Cephalexin. Now I’m just wondering how long will I still be with pain. For the past week all I done was rest the leg and it still hurt to just stand on it to take step

Dr. Runco 17-10-2016, 11:37

Bone marrow edema is similar to a stress fracture in how long it takes to heal. Plan on 6-8 weeks

Dr. Runco 17-10-2016, 11:39

you are describing a very complicated series of symptoms that may all relate back to the Rheumatism. Stick with your Rheumatologist

Helen Garrett 19-10-2016, 04:10

Hi Dr Runco I want to know with a Bone Marrow Edema I understand no weight barrier what other way you can get around can you wear a walking boot for this problem or just crutches. My orthopedic doctor put me off from work for the next six weeks. Then I go back for a follow update so is it best to stay off the leg or can I wear a walking boot and the stress fracture will heal

Karen 20-11-2016, 22:03

Hello,
I have a bone marrow edema of the talus. I was diagnosed in Sept 2016 and started experiencing pain may 2016. I recently had a baby in March and hadn’t been doing any heavy workouts or running since about 7 months pregnant. Prior history involves stress fracture in 2013 that healed. Low mileage runner since stress fracture. No working out or anything since pain developed post partum. Podiatrist said 1-2 years to heal and treat with cortisone shots. Shot helped for a week… is there any other way to help heal? My baby is almost 8 months old and I’m itching to run again – or walk without pain!

Dr. Runco 21-11-2016, 15:51

treating bone marrow edema with cortisone is not responsible, effective or ethical. Cortisone can actually do some long term damage in this case.
It is difficult for me to help you based only on what you provided me. A copy of your MRI report would be helpful.
I am also unclear as to when you started having the pain vs. 7 months pregnant or where your stress fracture in 2013 was located.
If you could provide me with a chronological timeline of your injuries and MRI report I may be able to help.

Stephanie 30-11-2016, 10:46

My husband has been having lowere leg pain for over 2 months. He is more of a weight lofter at the gym and dosent do much running. Maybe 1 mile a day. Since the pain started (over 2 months ago) he has stopped going to the gym. He sits behind a desk at work. He has seen the ortho and had an mri. This is what it said….
“There is a asymmetric painful marrow edema of the distal third of the right tibial diaphysis on the coral STIR sequence scanning which includes both distal legs for comparison with asymmetric anterior pertibial soft tissue swelling, peristaltic reactive change. There are small horizontal orentation street hairline fractures lines noted in the edematous marrow space of the distal right tibia on the T1 sequence scans which demonstrates minimally diminished marrow.”
Does he has marrow edema AND a sress frature? He is still having pain even after stopping the gym for so long..What are your thoughts? Thank you

Dr. Runco 01-12-2016, 05:25

I can help your husband mainly through advice and injury management protocols…..then future prevention. If you would like my help and guidance the below options are available
1. New patient exam at our Sports injury clinic in Kearney Mesa, San Diego. You can call to schedule an appointment at 858-268-8525. The cost is $167 for the exam and then $67 for any necessary treatment(s) the cost of which may be covered in part or in entirety by insurance.
2. A home based therapy program. This includes a list of any necessary home therapy products you will need for rehab plus a video tutorial of me showing you step-by-step instruction of the rehabilitative stretches, strengthening exercises, massage tools, the do’s-and-dont’s of returning to physical activity and a follow up email where you can ask any follow up questions regarding your case. The cost for this is $69.
3. A phone consultation. You send me the copy of your MRI report and a chronological history of your condition, the treatments tried and any other necessary information relevant to your condition. After our phone consultation I will send you a written treatment plan with specific instructions so that you may go to a doctor or therapist of your choice to implement it. The cost for this is $169. This is not covered my insurance and you can schedule it by calling 858-268-8525.

Erin 18-12-2016, 20:15

Good evening.

I am a long distance runner, and back in August, I was diagnosed with plantar fasciitis. I stretched and iced, BUT ended up changing my running form with my left foot due to the plantar fasciitis. I ended up having severe pain on the outside of my left foot and top of foot. I got X-rays which were negative, so the doctor said I could resume my running. A month later, the pain was worse. 2nd X-rays were also negative, so I continued running until I finally saw a podiatrist, got an MRI, and the results were: occult fracture/bone bruise in lateral cuneiform and 5th metatarsal. The podiatrist finally let me out of my boot after 8 weeks. The 5th metatarsal pain is gone, but the top foot pain is still hurting a lot, to where I am limping. The weird thing is, when I wear a shoe it feels better (pain not completely gone) but when I don’t wear a shoe, the pain is probably about a 6. The other thing that REALLY hurts (pain at a 9) is when I put all my weight on my left foot and try to go on my tiptoes. Any ideas?

bob 13-02-2017, 14:47

been having foot problems for 6 months now finally got mri results back
1. marrow edema compatible with contusion in base of 3rd metatarsal.
2. small full thickness cartilage defect of the 1st metatarsal head with subchondral marrow edema.
just wondering what this means in english and whats the best treatment. thanks

Dr. Runco 13-02-2017, 17:15

bone marrow edema is like a “pre-stress fracture” or a bone bruise on the interior……..the second finding has to do with your first toe and there is some cartilage damage and bone bruising beneath the cartilage.
As far as treatment…….rest from aggravation. So if impact aggravates it…you can’t do it for 6 weeks or so

Keri 23-02-2017, 11:24

Can you help? My daughter is 14 and is a huge dancer. It is her life & passion. She has been dancing on a HUGE swollen ankle for 3 years now. We went to our ortho Dr here 2 years ago and he put her in a cast. That didn’t work. We went back a few weeks ago and are now seeing a new Dr. She did another xray and then ordered an MRI. The MRI shows:
1. Moderate amount of fluid anterior & posterior ankle joint recess.
2. Small amount of marrow edema posterior inferior talus.
3. Mild posterior tibial tenosynovitis.
4. Small partial interstitial tear within the peroneus longus tendon along the lateral side of the calcaneus. There is also some tendinopathy signal within the peroneus brevis tendon.
5. Poorly defined calcaneal-fibular and anterior talofibular ligament fibers. May just be secondary to small ligaments or could be previous tears with some development of scar tissue. The corticated bone fragment distal to the lateral malleolus has normal marrow signal and is chronic.

So, now she is in a boot for 2 weeks and then has been told to do physical therapy and no dance for who knows how long. She is worried sick she is not going to dance again. I wish I could show you what her ankle looks like. It gets as big as a grapefruit. We ice it, she takes Advil. Do you have any advice?? Thank you so much!!

Susan orman 28-02-2017, 17:58

I am in desperate need of some insight. My 14 yr old son started baseball practice a month or so ago. 3 week ago while running his foot hurt, limping. X-rays are negative, MRI showed his foot lit up which I am told is unusual. They did blood work and bone scan – all negative. He has rested it in a boot, now has no pain at all. Doctor still won’t release him but can’t tell me any diagnosis. I did notice MRI saying something about edema. I can get the full results. Doctor then told my husband today that he is worried about the small bones and having a fracture … it is all odd and co fusing. Does any of this sound “normal” to you – I am the one suggesting the boot, crutches and MRI. He hasn’t offered any treatment other than the boot.
Me

Dr. Runco 01-03-2017, 08:57

It sounds like your son had/has bone marrow edema. Take a picture of the MRI report and email it to me so I can see for myself.
You said he now has no pain at all? How long was he in the boot?
It sounds like your doctor might not be familiar with these types of injuries. Common sense would say that if he rested in a boot for a period of time….and there is no longer any pain…..than the injury should be healed. I mean, if he had no pain in the first place you would never have seen the doctor. I look forward to getting the MRI report.

Dr. Runco 01-03-2017, 09:04

Keri the MRI report is outlining the cause of the problem in that it points out the posterior tibial tenosynovitis, torn peroneus longus tendon and tendonopathy in the peroneus brevis tendon and finally the damaged calcaneal-fibular and anterior talofibular ligaments.
The real question is what is it going to take to heal this. In my opinion traditional physical therapy has a minimal chance of helping. Time in the boot of as long as 3 months may be necessary…..but I am a big fan of progressive physical medicine so would lean towards PRP injections followed with a progression from isometric resistance to eccentric resistance and finally AlterGravity Treadmill rehab. You can email me directly at Drrunco@sdri.net or call my clinic at 858-268-8525 to set up a consultation either via phone or in our San Diego clinic.

Debabrata Biswas 01-03-2017, 15:09

MRI of my right ankle joint suggests the following :-
1.Grade II tear seen in Tendo Achilles about 3 cm. from insertion.
2.Fracture seen in lower fibular shaft with marrow edema.
3.Diffuse intramuscular hematoma.
4.Grossly narrowed tibiotalar and talocalcaneal joints
Sir,I am 45 years old and presenly having pain.Kindly convey your valuable comments, sir.

Nisha King 01-03-2017, 19:40

Hi Dr.Runco,

I am 21 year old female who recently started back running in January with a program at my university after years of nothing do it but instead of sprinting it was more long distance running this time. During the first practice, I started to feel the pulling of the muscles in my right and left leg but more so in my right. It only got worse the more I ran so I just would walk it off and ice it when I got home. This continued to happen through the next few practices to the point where I did not want to run because the pain was too much. After the first practice, I went to get fitted for the proper running shoes and was given brooks adrenaline 17 which are suppose to be give my feet some support and help with my flat feet but when i use it the next few practices after the pain was only worse than before.

I went to see the sports doctors at my university and she said that I have MTSS [ Medial Tibia Stress Syndrome]. During the appointment, she felt up and around the bone and there was a specific area on the inside of my right leg that when she touched it sent a sharp pain through my leg. She used the tunning fork and I felt the vibration in the area but no pain. I also did the single leg jump test there was a little pain but not so much. From this i was told to have an X-Ray. She also said that i have a dynamic valgus & knees & dynamic pen planus, she said to do physiotherapy for hip/core/pelvis for stability. A week later, I see her for the results the X-Rays comes back as negative but during the week after i saw her i have been feeling pain whenever I walk. Its more like an dull pain but whenever I try to walk faster I can feel the same muscles tighten up from when I was running and have to stop or slow down to ease the pain. As a precaution because she feels like it is the earlier stages before a stress fracture, she gave me an aircast and crutches for 3 weeks with non-weight bearing to relieve the pain and schedules an MRI and also not to run at all. But I was wondering if she is right ? that I should be using the cast even if the pain is when i am walking fast ? or could it be something else ?

Thank you,
Nisha

Nisha King 01-03-2017, 19:44

Forgot to say that in the second appointment she diagnosed it as a Right Tibial stress reaction

Dr. Runco 02-03-2017, 12:57

not only could she be right she is doing everything right by you including ordering an MRI. Listen to her

Dr. Runco 02-03-2017, 12:57

A stress reaction is either stress fracture or bone marrow edema

Dr. Runco 02-03-2017, 12:58

Are you asking whether or not to have surgery for your achilles? Grade 2 does not require it. You can wear a boot with a heel lift, get PRP then rehab on an AlterG treadmill and perform eccentrics for therapy.

Nisha king 02-03-2017, 18:21

Okay I will Definitely listen to her. I have just been getting a lot of people telling me might be this or that and it’s pretty confusing. I was asking in terms of I have the air cast on and when I walk with it on I feel a sort of pain right about the bottom of of leg

Lori 10-03-2017, 09:44

My daughter hurt her ankle November 1 when she was knocked down at PE. She had twisted it a little a week before and had said it hurt a little but wasn’t limping. After the fall however, she could barely walk limping it hurt so much. X-rays showed no fractures. She was given a boot and crutches because it was suspected that she had fractured it so she used the boot until we saw the specialist. The boot caused more swelling so we went to just using crutches. Was told after a second set of X-rays it was just a bad sprain. She had the color changes occurring during this time too. She went through PT in December/January and started PE again after. She complained of it still bothering her after PE sometimes and she couldn’t walk fast still. Then after a timed run on February 22 she couldn’t walk again. She had an MRI a week later that showed bone marrow edema. She’s been using crutches since and just now feels like it can hold more weight to limp around more without crutches. I want to make sure she isn’t doing much too soon so it will heal all the way this time. The doctor said he didn’t want her one crutches too much longer so we don’t have to also worry about atrophy. She is still having the color changing but she also had times where it felt ice cold and that seems to be better. Her next appointment isn’t until March 30 and she is excused from PE until then too. How long do these injuries usually take to heal? Do you know what the re injury rate is? I am wondering if this is something that will bother her the rest of her life. Thank you

Jacalyn 14-03-2017, 01:02

I have a spur on each foot, torn ligament. On left ankle, arthrist. In both feet,had a heel fracture on right foot (now its heeled i also had a fractured ankle on right foot its healed) i alsohave bone marrow adema in both feet. Ya my legs and feet swell, my leg has had red. Big spots like a rash but in big patches it comes and goes, im itchy all the time my whole body. Can you help me. I go get second opion tomarro tomarrow

Dr. Runco 14-03-2017, 08:22

Lets see what the second opinion says then email me at drrunco@sdri.net Jacalyn

Dr. Runco 14-03-2017, 08:24

Hi Lori,
I thought I has answered this so forgive me is I am repeating myself. The reinjury rate is about 17% according to some studies. Bone marrow edema should heal within 6 weeks assuming no aggravation.

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