Bone Marrow Edema and Ankle Instability

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Hi there Dr. Runco,


I found you via google and you’ve become my last resort after 4 orthopedic surgeon visits, chiropractors, podiatrists and now in twice a week physical therapy.

Clueless is dangerous

Clueless is dangerous

Wow….that is a lot of hands in the proverbial pot!  Do they all agree on what is wrong and how to correct it or are they all offering differing opinions and solutions?

I’m hoping you can help and have attached my MRI report to this email.

I have read it and it appears you have suffered multiple injuries to your ankle with this not being the first time.  You partially avulsed one of your ligaments and sprained another which is resulting in instability to your ankle joint.  The instability and misalignment is then resulting in tendonosis and bone marrow edema in the ankle bones (talus).  This needs to be fixed.  

I’ve had a history of injuring my left ankle, but in late October (after a few weeks in vibram 5 finger shoes), my entire foot began swelling and becoming very painful. The lateral part of my ankle has swelled chronically since August 2015 after what I think was undiagnosed peroneus brevis tendinopathy – but it was manageable – I could still walk with orthotics.

Based on the MRI you suffered significant damage to your ankle in the incident in August 2015 which led to the instability…..which in turn led to the tendonosis.  The Vibrams having no support exposed your ankle to even more instability.

I resprained my ankle in September 2016, took out my orthotics, switched to Vibrams and it all went very very wrong.

Based on the MRI the ligament injury worsened and because of the instability your ankle bone (Talus) was subjected to abnormal impact forces which led to the bone marrow edema

After a long haul flight to Australia, I got off the plane and could put no weight on my foot due to swelling. It wasn’t just ankle swelling anymore though – my entire foot and both lateral and medial sides of my ankle were severely swollen and I am experiencing pain on both sides of my ankle.

The MRI shows damage to both the medial and lateral ankle.  The swelling in the ankle is preventing circulation from moving back and forth effectively beyond the swelling in your foot.  This results swelling and pain in the entire foot.

I went on a 1 month adventure of getting MRIs, Ultrasounds, CT Scans, Bone Scans and Blood Work to determine why my entire foot was swelling when any weight was put on it.

I am sorry you were put through all of this unnecessary testing. The MRI result shows the reason why your foot swells.

My surgeon told me he couldn’t explain it – but I’m wondering if the bone edema and bone contusion that showed on my MRI might have anything to do with it.

Your surgeon is a knucklehead and should go back to orthopedics 101

Currently in new orthotics (even in my moon boot) which are helping with the medial ankle pain – but the swelling is driving me nuts. I’m on prednisolone to help manage it, but this isn’t a long term solution.

The long term solution is to repair the ligaments in your ankle.  There is a protocol for this that is highly effective.  You do not have a prednisone nor orthotic deficiency.

Is it possible for a bone edema (in fibula) and bone contusion (talus) to be causing my entire foot to swell? All the way down to the tips of my toes?

Yes. The MRI shows damage to both the medial and lateral ankle.  Specifically to the ligaments (torn and avulsed), bone (marrow edema) and joint instability causing peroneal tendonosis. The swelling in the ankle is preventing circulation from moving back and forth effectively beyond the swelling in your foot.  This results swelling and pain in the entire foot.


I’m still weight baring in the foot but wondering if I should be on crutches as well.

You need to be given the correct protocol to repair your ligaments without surgery and then how to properly rehabilitate it.  Crutches, boots and orthotics will not accomplish this.
I’ve been in the boot for 6 weeks now with minimal signs of improvement.

By not weight bearing on it or not moving it will feel better but will never repair.  Email me at or call my clinic at 858-268-8525 and we can schedule you for a ½ hour phone consultation.  I will explain the injury to you and provide you with an effective path to repair the ligaments and joint instability then a rehabilitation plan.

Any help would be greatly appreciated,



By | 2016-12-17T06:11:19+00:00 December 17th, 2016|Running Injuries, Sports Injuries|0 Comments

About the Author:

Dr. Runco is a U.S. Navy and Gulf War Veteran. He began private practice in 2000 primarily treating and fixing running injuries. He has been a professor of Anatomy, Physiology, and Biomechanics at various colleges and continues to teach continuing education in the fields of rehabilitation, custom orthotics and athletic taping. He is also a member of the American College of Sports Medicine, National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. He has completed over 15 Marathons in 15 states and has run 11 50 mile Ultramarathons.

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