Bone marrow oedema (BMO) describes increased fluid within the bone marrow and is a finding seen on magnetic resonance imaging (MRI). When it occurs within the calcaneus, or heel bone, it may contribute to persistent heel pain. Although many patients have never heard of bone marrow oedema, it is an important diagnosis because it cannot usually be detected on a routine X-ray and may coexist with plantar fasciosis or other heel disorders.
BMO is not a diagnosis in itself. Instead, it is a sign that the bone is responding to abnormal stress or injury. It may develop because of repetitive overload, a stress reaction, altered biomechanics, trauma or prolonged abnormal loading caused by another condition such as chronic plantar fasciosis. Identifying the underlying reason for the bone marrow oedema is just as important as recognising that it is present.
Patients with calcaneal bone marrow oedema often describe a deeper aching pain within the heel than is typically experienced with isolated plantar fasciosis. The pain may increase with prolonged standing, walking or impact activities and can persist even after periods of rest. Because symptoms overlap with other causes of heel pain, clinical assessment remains essential.
MRI is the investigation of choice for identifying bone marrow oedema because it provides excellent visualisation of the internal structure of the calcaneus. On MRI, the affected area demonstrates characteristic signal changes that cannot be appreciated on ultrasound or conventional X-rays. Ultrasound remains valuable for assessing the plantar fascia and surrounding soft tissues, while MRI provides complementary information about the bone itself.
The presence of bone marrow oedema does not automatically mean that surgery is required. In many patients, symptoms improve once the factors causing excessive mechanical loading are identified and managed appropriately. The key is recognising the condition early and incorporating it into a comprehensive treatment plan rather than focusing on a single imaging finding.
Ultimately, bone marrow oedema reinforces an important principle that runs throughout this handbook: successful treatment begins with an accurate diagnosis. Understanding whether the pain is arising from the plantar fascia, the heel bone, an irritated nerve or a combination of conditions allows treatment to be tailored to the individual rather than relying on a one-size-fits-all approach.