Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost

Abstract

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 μg 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.

Efficiency of iloprost treatment for osseous malperfusion

“…Aigner et al successfully treated patients with BME of the forefoot and the acetabulum in 2001 and 2002 with iloprost [10,12] and first demonstrated a clinical benefit, especially in early stages of the disease. Meanwhile, these findings were reproduced by further studies [1,13,24,25].…”

“…The use of iloprost for the treatment of painful BMO (compartment syndrome of the bone) and AVN represents an off-label-use at present. Due to promising results of other groups [8][9][10][11][12][13] and to our own positive experience [14] we started a prospective study on the curative potential and analgesic efficiency of iloprost in 2002 as previously reported [1]. our institution.…”

Bilateral transient osteoporosis of the talus in pregnancy

“…Although considered rare, TOH is a wellestablished complication of the late second to early third trimester of pregnancy [2]. Transient osteoporosis has rarely been reported to affect the knees, but previous documentation of talar involvement has been sparser [3][4][5][6][7][8].…”

“…Multiple treatment modalities have been utilized including traction, physiotherapy, glucocorticoids, nonsteroidal anti-inflammatory drugs, calcitonin, sympathetic blocks, and sympathectomy in nonpregnant patients but none seem to influence the natural course [11,18]. A small series describing the successful treatment of TOT with parenterally administered iloprost has been published [3]. Core decompression of the talus was also shown to have an excellent or good Mazur score in 14 of 17 ankles after a mean follow-up of 7 years [6].…”

Iloprosttherapie bei systemischer Sklerodermie

“…Iloprost wird bei peripheren arteriellen Verschlusskrankheit Stadium IV nach Fontaine verabreicht, wenn eine lumeneröff-nende Therapie nicht möglich ist.Eine weitere Indikation ist ein schweres RaynaudSyndrom als Folge von Kollagenosen,insbesondere bei systemischer Sklerodermie [12].Weitere Indikationen für eine Iloprosttherapie sind Erfrierungen [11],pulmonale Hypertonie, hier in erster Linie mit inhalativer Anwendungsform [22,23], Thromboangiitis obliterans [9], Ulcus cruris venosum [27],aseptische Knochennekrose und Knochenmarködem [1] sowie Pyoderma gangraenosum [19].…”