iloprost and Foot-Diseases

The parenteral application of the vasoactive drug, iloprost, might be a viable option for the treatment of BMES of different origins, especially ischemic ones. In edema that is secondary to osteoarthrosis or stress, the effect of therapy with iloprost depends on the grade of the basic disease. The natural course of the disease, as well as the normalization of the signal pattern of the MRI, seem to be accelerated.

Topics: Adult; Aged; Bone Marrow Diseases; Edema; Female; Foot Diseases; Humans; Iloprost; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Pilot Projects; Prospective Studies; Vasodilator Agents

Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.

Topics: Adult; Bone Marrow; Edema; Female; Foot Diseases; Forefoot, Human; Humans; Iloprost; Metatarsal Bones; Metatarsus; Osteotomy; Pain; Vasodilator Agents

Bone marrow oedema syndrome of the talus is a rare cause of pain in the foot, with limited options for treatment. We reviewed six patients who had been treated with five infusions of 50 microg of iloprost given over six hours on five consecutive days. Full weight-bearing was allowed as tolerated. The foot score as described by Mazur et al was used to assess function before and at one, three and six months after treatment. The mean score improved from 58 to 93 points. Plain radiographs were graded according to the Mont score and showed grade-I lesions before and after treatment, indicating that no subchondral fracture or collapse had occurred. MRI showed complete resolution of the oedema within three months. We conclude that the parenteral administration of iloprost may be used in the treatment of this syndrome.

Topics: Adult; Aged; Bone Marrow Diseases; Edema; Female; Foot Diseases; Humans; Iloprost; Magnetic Resonance Imaging; Male; Middle Aged; Pilot Projects; Prospective Studies; Vasodilator Agents