Bone Edema
What is bone edema?
Bone edema is the pathology characterized by the accumulation of fluid of inflammatory or vascular origin inside the bone. In the bones we distinguish between compact bone tissue and spongy or trabecular bone tissue. The latter is less dense because it has spaces where the bone marrow and a large number of blood vessels are located. In the event of an aggression suffered by the bone (trauma, excess load…) these vessels can be affected and break, which generally causes the accumulation of liquid and/or blood inside the bone, causing inflammation of this area and edema at this level. A poor prognosis of this injury can lead to a more serious injury such as a stress fracture.
Why does bone edema occur? Where does it usually appear?
The most common causes are:
- Both compression trauma (direct trauma).
- Distraction (tension generated by a ligament or tendon on the bone).
- The accumulation of repeated microtrauma (overuse) generated by overload.
- A degenerative lesion.
In general, bone edema usually occurs in bones related to weight bearing and in subchondral articular areas (below the articular cartilage), being the most frequent in talus, calcaneus and metatarsals, and can also be found in bones such as those of the carpus (scaphoid, pyramidal…) due, for example, to a fall with palmar support.
How do I know if I have bone edema?
For the correct diagnosis of bone edema, apart from the symptoms and the physiotherapist‘s assessment, it is necessary to perform a magnetic resonance imaging (MRI), since with an X-ray we cannot observe the liquid or the soft tissues.
What is the symptomatology of this pathology?
Regarding the symptomatology of this injury, the main symptom is localized pain in the affected area, which increases with activity or increased load and decreases with rest.
In the case of an acute or more severe injury, the pain may limit daily activities such as walking or climbing stairs and may appear even at rest.
In the case of the lower limb, orthotics or orthopedic stockings such as insoles may be prescribed to reduce pressure in the area, including walking aids that allow the patient to unload as little weight as possible on the affected area.
The resolution times of the bone edema are variable and depend on many factors (evolution, localization, origin, severity…) but, as a general rule, considerable symptomatological improvements are not expected in less than 4 weeks and may last up to 6-8 months. It is necessary to treat as quickly as possible the bone edema to avoid major problems because if for a long time the blood supply does not flow normally through the bone and the inflammatory fluid that produces the edema is not reabsorbed by the body, this injury can lead to a stress fracture or osteonecrosis, deteriorating the bone and even the joint.
What is the treatment for this injury?
Regarding the treatment of this type of pathology, it is essential to activate the circulation in the area and above all rest, which is the first and most important therapeutic intervention, always seeking to reduce mechanical stress in the affected area.
The therapeutic plan
Its main objective will be the reabsorption of the liquid accumulated in the bone, since its presence alone can lead to pathologies of worse prognosis such as fractures or osteonecrosis (death of the involved area of the bone). Another very important factor for a quick recovery will be the degree of involvement of the patient, both in the treatment itself and in the rest, being the simplest and most effective but at the same time the most difficult as it determines our daily life limiting physical activity and work.
Conventional treatment
We apply magnetotherapy due to its draining and anti-inflammatory effect, high power laser, cryotherapy and / or application of contrast baths. Depending on the evolution and in more advanced stages of the injury, we rely on musculoskeletal physiotherapy techniques with specific mobilizations of the structures involved to achieve normalization of the patient’s function. As a final part of the treatment, it is advisable to add active work, focusing mainly on increasing proprioception and strength with the prescription, supervision and performance of therapeutic exercise.
Advanced treatment
We highlight capacitive diathermy (INDIBA), as well as EPI or NMP with the objective of reducing pain and inflammation and achieving improvements in the patient’s functionality.