J Korean Foot Ankle Soc.  2019 Dec;23(4):183-188. 10.14193/jkfas.2019.23.4.183.

Improvement of Pain according to Magnetic Resonance Imaging Classification in Bone Contusion around Foot and Ankle

• Kim HJ
• Lee KB

• KMID: 2465942
• DOI: http://doi.org/10.14193/jkfas.2019.23.4.183

Abstract

PURPOSE
Bone contusion is usually treated with conservative therapy for 3 months. Bone contusion around knee and hip joints has been extensively reported on, but there are scant reports on this condition in foot and ankle joints. This study evaluated the nature, characteristics and location of bone contusion around foot and ankle joints to enlighten clinicians on how to better treat this disease entity.
MATERIALS AND METHODS
We classified bone contusion of the 76 patients into three types (102 sites; 47 ankle sprains, 18 traffic accidents, 11 falls) according to the Costa-Paz system with employing magnetic resonance imaging (MRI), and the study then analyzed the common sites and areas of occurrence according to the mechanism of injury and duration of pain after first conducting conservative therapy.
RESULTS
Of the 76 patients (102 sites) on the MRI, 43 case (42.2%) for talus, 19 cases for distal tibia, and 12 cases for calcaneus were involved. The classification, according to the Costa-Paz system, was Type I, 51 cases; Type II, 32 cases; and Type III, 19 cases. The duration of pain after conservative treatment was 12.15±2.17 weeks for Type I, 14.5±2.15 weeks for Type II, and 21.0±3.8 weeks for Type III.
CONCLUSION
The most common location of post-traumatic bone contusion around both the foot and ankle is the talus, distal tibia, and calcaneus. The most common type of injury noted on MRI is a diffuse signal with change of the medullary component (Type I), In cases of bone contusion extending to a subjacent articular surface or disruption or depression of the normal contour of the cortical surface (Types II, III), the patients' pain appears to last longer. Thus, it is necessary to consider a longer period of conservative treatment in cases of Types II and III bone contusion because the patients' pain may last longer than 3 months.

Keyword

Bone contusion; Magnetic resonance imaging; Foot and Ankle

MeSH Terms

Accidents, Traffic
Ankle Injuries
Ankle Joint
Ankle*
Calcaneus
Classification*
Contusions*
Depression
Foot*
Hip Joint
Humans
Knee
Magnetic Resonance Imaging*
Talus
Tibia

Figure

• 

  Figure 1 (A, B) A 63-year-old female that slipped from the mountain tracking presented pain on right foot dorsum medial side. We confirmed bone contusion in the form of diffuse signal change of medullary component of navicular bone on magnetic resonance imaging (MRI). The visual analogue scale (VAS) score at the time of first visit was 6 points. Her pain was tolerable after 9 weeks (VAS score 2). At 16 weeks, she had little pain (VAS score 1). (C, D) A 41-year-old female that falls from a height 1 m presented lateral side pain of foot dorsum. We confirmed bone contusion in form of extending subjacent articular surface of cuboid bone on MRI. The VAS score at the time of first visit was 8 points. She complained of pain even at 12 weeks (VAS score 3). She had tolerable pain at 15 weeks (VAS score 2). (E, F) A 53-year-old male that falls from a height 1 m presented medial malleolar area pain. We confirm no fracture around foot and ankle on plain radiographs and computed tomography. But we found bone contusion of medial malleolus, we can see normal plain radiography and bone contusion with cortical disruption in medial malleolus on MRI. The VAS score at the time of first visit was 7 points, and VAS score at 12 weeks was 2 points.

• 

  Figure 2 The incidence of bone contusion according to injury mechanism. Slip down injury is a leading cause of injury mechanism.

• 

  Figure 3 Visual analogue scale (VAS) score change and pain duration by bone contusion classification.

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