Onbegrepen pijn van de enkel en voet

Transient osteoporosis is an increasingly recognized condition that causes severe pain in weight-bearing joints and is characterized by otherwise unexplained bone-marrow oedema on MRI. We present two patients, a 40-year-old man and a 60-year-old woman, with longstanding severe pain in the foot and ankle. Both had invalidating pain with only mild swelling of the foot or ankle. Laboratory investigation was unremarkable, and conventional X-ray showed osteopenia of the bones involved. In both cases, consecutive MRIs showed migrating bone marrow oedema. The patients were treated with analgesics, immobilization of the body parts concerned and an intravenous bisphosphonate.

The exact aetiology and pathophysiology of transient osteoporosis is unknown. It is a self-limiting condition, which usually resolves within six to 24 months. Treatment is conservative, and usually consists of prescription of analgesics and immobilization of the body part involved. A variety of additional treatments have been used successfully, with most evidence for bisphosphonates.

Conflict of interest and financial support: none declared.