Subchondroplasty - A Viable Treatment Option for Transient Bone Marrow Edema Syndrome of the Navicular in an Adolescent: A Case Report

Introduction: Transient bone marrow edema (TBME) is a condition that typically presents in middle-aged adults with a male to female ratio of 3:1. Cases have also been noted in females during the third trimester of pregnancy. Vitamin D deficiency has been linked to this condition as the pathophysiology demonstrates poorly mineralized osteoid in presenting lesions. It is rare for a healthy child or adolescent to present with TBME introducing the purpose of this case study. This case report aims to provide medical and surgical education on TBME in a young and healthy adolescent. To our best knowledge, this is the first report on the use of subchondroplasty to treat transient bone marrow of the navicular in an adolescent male.

Case report: A 16-year-old adolescent male with foot and ankle pain is treated from September of 2017 to September of 2019. The patient failed initial conservative treatments. His treatment concluded with subchondroplasty of the navicular bone, typically contraindicated due to the risk of avascular necrosis (AVN). The patient received follow-up in March of 2020, which included additional magnetic resonance imaging (MRI) for long-term treatment outcome data.

Conclusion: The patient was successfully treated with subchondroplasty after conservative therapy failed. In patients with TBME, subchondroplasty may not be the best option due to risk of AVN. At 1-year follow-up, our patient was asymptomatic and MRI showed reduction in edema.