I had a patient that came into the office today and she had a painful portion of her foot. On her right foot she had pain recently because she was compensating for her left foot surgery. It is common when someone has left foot surgery they put more more pressure on the other foot.
She developed a bone bruise. When we got an MRI it showed that she had something called the “bone marrow edema.” Edema is nothing more than swelling that happens inside of the bone.
To explain a little bit easier think about a normal bruise that you have on your skin. What happens is you get the swelling and that area gets hard and becomes black and blue as increased blood goes to the area. Overtime the swelling calms down and the bruising goes down on the skin. This same process can take a number of weeks to happen before you feel normal again.
The same thing can happen on the bone. If you put increased pressure on the bone with repetitive movements such as running or putting more pressure on it because you’re trying to alleviate pressure from another area of pain this can create increased bone stress over that area.
Typically the inside of the bone becomes swollen and more blood goes to that area and if the swelling stays there there’s a bone bruise if the swelling increases and the person doesn’t stay off the painful foot then it needs a place for that extra swelling to escape it usually can escape only through a weakness in the bone causing a small crack. That crack is called a stress fracture. Therefore, a bone bruise happens before a stress fracture. The challenging thing about the situation is that a bone fracture takes 4 to 6 weeks to heal but with a bone bruise we don’t know how long it takes to heal it may even take a longer amount of time. There are two ways of thinking about it some people say go walking on your feet as much you want if it cracks then we have a fracture and we can treat that in 4 to 6 weeks. Other people say, if it’s a bone bruise stay off it with crutches until it feels better.
You’re probably wondering what I’m going to do with this patient. She is going to start with walking on her foot and use a topical gel called Voltaren gel to put on for the pain. If over the next two months of walking normally the pain does not go away I’m going to keep her nonweightbearing with crutches or specialized walking boot and order a bone stimulator.
I hope this helps.
To your health,
Dr. Donald Pelto.