Initial Experience with Subchondral Stabilization for Bone Marrow Lesions of the Midfoot and Forefoot

Abstract Disabling foot pain is often accompanied by MRI evidence of bone marrow edema which may represent early structural fatigue. Emerging evidence suggests subchondral stabilization with injectable calcium phosphate can alleviate pain associated with bone marrow edema in the hindfoot, ankle and knee; however, there is no data supporting its use or safety for midfoot or forefoot lesions. We identified 54 patients who underwent SS of various midfoot/forefoot osseous structures in our practice over a four-year period. All patients proved recalcitrant to standard conservative measures, and all had advanced imaging appreciating BME. VAS for pain at 1, 3, 6, and 12 months postoperatively served as the primary outcome measure. 41 patients were included with a mean age of 54.3 ± 14.9 years and mean follow up of 14.1 ± 6.9 months. Patients saw a significant decrease in VAS pain as early as 1 month postoperatively (p<0.05). Mean postoperative VAS at 12 months was 2.11 ± 2.50, and the mean reduction in VAS pain from preop to 12 months postop was -5.00 (95% CI -3.44 to -6.56, p<0.05). Fourteen patients (34%, 14/41) were pain free at 12 months. Treatment of more than one bone (unadjusted OR 6.23 [95% CI 1.39 to 27.8], P=0.017) was associated with a greater likelihood of not achieving a pain free status at 12 months. Initial experience suggests that SS was both safe and effective in our patient population. Simultaneous treatment of multiple bones should be entered into with caution, and further research on the subject is necessary. Level of Evidence: IV (Retrospective Case Series)