Effectiveness of hyperbaric oxygen therapy in foot and ankle bone marrow edema

Objectives: In this study, it has been observed that there is a limited number of studies regarding the effects of hyperbaric oxygen therapy (HBO) on bone marrow edema (BME), especially focusing on the foot and ankle. This study aims to determine whether HBO is a non-invasive, effective, and safe therapeutic method for BME in the foot and ankle. In this context, a positive effect is expected in terms of reducing symptoms and shortening the return to daily life. The results of this study will help us better understand the potential value of HBO for BME treatment in the foot and ankle. Materials and Methods: In our retrospective study, conducted on patients with bone marrow edema in the foot and ankle referred to Ankara Bilkent City Hospital, 30 sessions of hyperbaric oxygen therapy were administered. The patients' pre-treatment symptom severities, clinical and pain scores (VAS), foot functionalities (EFAS), and radiological evaluations were recorded. After treatment, symptom severities, clinical and pain scores, and radiological evaluations were compared. Additionally, the effects of additional variables on improvement were examined. Results: The average age of the patients is 49.3; 36.4% are male, and 63.6% are female. Before HBO treatment, the patients' VAS scores were median 8.05 (3-10), and after treatment, these scores significantly decreased to 2.86 (0-9). This difference is statistically significant, as the p-value is 0.003 (below 0.05). Furthermore, the pre-HBO EFAS score was median 9.86 (6-20), and after treatment, it was determined as 13.9 (7-20). This indicates a 35.23% effectiveness of HBO treatment, although the p-value is 0.0094 (below 0.05). When MR images were examined, significant improvement was observed in 86.4% of patients, with a p-value of 0.0000 (below 0.05). Conclusion: In our study, significant reductions were detected in BME findings in groups treated with HBO. However, despite these positive findings, caution should be exercised regarding the strength and generalizability of the results. Despite the challenges, it is important to note that the study provides significant findings. For future studies, considerations may include adding control groups to improve the study design or conducting prospective studies with larger patient samples. Such improvements can contribute to the reliability and generalizability of the results obtained. Additionally, we are considering collaborating with hospital staff or relevant research teams to facilitate easier access to patients' past MR images