Marathon runner's heel pain diagnosed as bone marrow edema, not just Achilles tendonitis

A 42-year-old marathon runner in Changhua, Taiwan, suffered from heel pain for half a month, initially misdiagnosed as Achilles tendonitis. Despite rehabilitation and injections, the pain persisted, prompting a visit to Yuanrong Medical System's Yuanrong Hospital.

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The patient's injured area, indicated by the finger, is the inside of the heel bone.

There, doctors discovered the pain stemmed not only from swollen Achilles tendons but also from bone marrow edema within the heel bone. Advanced imaging, including MRI and musculoskeletal ultrasound, confirmed significant swelling and abnormal blood flow around the tendon, alongside the bone marrow edema. This indicated that the bone itself was affected, contributing to the chronic pain.

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The Achilles tendon not only showed significant swelling, but the ultrasound also revealed abnormally increased blood flow around the tendon. Furthermore, the MRI found bone marrow edema within the heel bone, indicating that the source of the pain was not just the Achilles tendon itself, but the bone had also been affected.

Treatment involved injecting autologous platelet-rich plasma (PRP) directly into the heel bone to promote healing of the damaged bone marrow and tissue. Additionally, tendon injections were administered to improve the tendon's repair capacity. Recognizing that abnormal new blood vessels and nerves around the tendon were causing persistent pain, the team collaborated with the cardiovascular center to perform a minimally invasive micro-arterial embolization. This procedure blocked the abnormal blood flow, reducing inflammation and alleviating pain.

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We first treated the bone marrow edema in the heel bone using autologous platelet-rich plasma (PRP) bone marrow injection therapy, utilizing growth factors in the platelets to promote the repair of damaged bone marrow and bone tissue, accelerating healing.

Following treatment and continued rehabilitation, the runner gradually resumed training. Within two to three months, they increased their running volume and successfully completed a full marathon six months later, regaining their previous athletic ability. Doctors advise that persistent heel pain, unresponsive to initial treatments, warrants further investigation for underlying issues like bone marrow edema or stress fractures to ensure accurate diagnosis and effective treatment.

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We performed micro-arterial embolization under local anesthesia, using a catheter to locate the small artery supplying the abnormal vessels and then using embolic particles to block the abnormal blood flow, thereby reducing inflammation and pain. It is a minimally invasive treatment.