Tuesday, September 8, 2009

Calcaneal (heel bone) Cyst & Tumors


Last week, a 14 year old girl showed up to my office with intense right heel pain. The patient was an avid basketball player and was having difficulty with running and keeping up with her teammates due to the severe right heel pain. After examination of the patient's right heel, I decided x-rays were warranted to rule out a stress fracture and any other problems that might be present.
Upon taking the x-ray, this is what I saw. See the x-ray below.

As you can see, there is a large "hole" in the calcaneus or "heel bone". This is actually not a "hole" but rather a large cyst or tumor that has developed over many years.
These cysts or tumors can become painful, especially with increased pressure on the heel during weightbearing and athletic activities. Sometimes, if the calcaneus is under too much stress, the bone can fracture and cause severe problems. This is primarily due to the lack of bone and structural integrity within the calcaneus where the cyst or tumor has developed.

There are many types of cysts or tumors that can develop in the calcaneus. I will am going to cover the most common tumors of the heel bone and show pictures of them.

The picture to the left is called an "interosseous lipoma". An interosseous lipoma is a benign tumor made of adipose or fat tissue that develops inside the bone.

This picture demonstrates an "osteoid osteoma." This benign tumor has a central hardened core surrounded by soft bone. It occurs in younger people and the pain is usually at night and is relieved by aspirin.

This picture shows a benign lesion called an "enostosis." These are usually non-painful and do not have to be removed.

This is another picture of an interooseous lipoma as mentioned above.

This is another interosseous lipoma with some calcification in the center of the lesion.

This picture shows a simple (unicameral) bone cyst. This cyst is usually removed and packed with bone chips to prevent fracture of the calcaneus or heel bone.

This is also a simple "unicameral" bone cyst.

Although just about any tumor or cyst can be found in the calcaneus, the pictures above show the most common.

For the young girl mentioned at the beginning of the blog, the following treatment was given.
The patient was advised to remain non-weightbearing on the right heel.
She was advised to stop playing basketball, due to possible fracture of the calcaneus or heel bone.
She was advised that if the calcaneus fractures, she could possible have resultant arthritis to affect her the rest of her life.
She was sent to have an MRI of the right calcaneus to determine the exact size of the cyst and the consistency of the fluid inside of the cyst.
Patient was to be seen following the MRI and determine a date to have the tumor resected.


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  2. Tucson, AZ mother of 3August 12, 2011 at 8:45 PM

    Thank you so much for this informative site. I was just diagnosed with a calcaneus cyst or tumor to my right foot and your description describes my foot issue to a tee. It is very painful especially during exercise and wakes me from a sleep. Your site has helped me to better understand the potential road that may be ahead and to calm my thoughts of it being something much more serious. MRI with contrast has shown a great picture of this tumor but a CT may be in order for some to verify it is is not CA, which from my understanding is quite rare.

  3. This was informative. I have a 1cm calcaneus cyst, it looks huge on an x-ray, but 1cm doesn't seem that big. The pain associated with the 1cm cyst is horrible. I had an MRI after trying to take it easy on my foot for 4 weeks. I am now wearing a cast for 4 weeks and then a walking boot for a while. Surgery was not recommended due to the location of the cyst being directly on the bottom of my heel and where all my weight is placed when I take a step. My heel hurts as I am sitting here and I haven't walked on it in over a week. There is something to say for taking care of your feet!!

  4. Hello

    I have my calcaneous bone growing and the skin over it is dead. X-Ray show growing bone. Can it be a tumor???

  5. My daughter, age 49, had surgery for this condition after years of pain. After finally getting a diagnosis on an MRI showing what looked like a golf ball sized cyst it was removed. She was non-weight bearing for over 3 months. She is still in a lot of pain. Is it possible that this could come back? She also had an MRI on the other heel after feeling similar pain t also showed the same thing although not as large.

  6. may i ask who this little girl was ? my sister is 14 and she has this same thing going on with her . i will pray for this little girl that she gets better along with my sister..

  7. I had surgery to remove my tumor almost a year ago. I do not have the pain anymore. some days when I'm up on my foot a lot it does seem to get sore. but I'm happy with the outcome. was non weight bearing for six weeks.

  8. Doctors just diagnosed me with a cyst. I am a 31 year old overweight but athletic man. Pain in my feet and heels comes often but never would have thought it shouldn't be this bad. Praying for all the best when I get my MRI tomorrow.

    1. I have a large cyst in my heel bone also, I'm 36. Mine hurts on the side of my heel bone and up my ankle. Does anyone else have an intense burning pain sometimes when you sit in one position to long and then move your foot? Most of the time thespian is so bad I can't walk on my foot at all.

  9. Yes I get the burning pain, same thing waiting for my mri to confirm and make sure it's not a fracture

  10. Yes I get the burning pain, same thing waiting for my mri to confirm and make sure it's not a fracture

  11. I had a large bone cyst removed and filled with 17cc of live/frozen chips. I also had 2 heel fractures one being on the bottom of the heel from the cyst. Of course I had to have both peroneal tendons repaired(vertical tears) and they scored my Subtalar joint. $61k surgery. I'm three weeks out and still non weight bearing. Ended up being much more involved than I had initially hoped.

  12. I have had heel pain for a few weeks now. I have difficulty walking and standing . My whole leg hurts but most the heel (right) i am 17 and i just thought it would be because of shoes i use . I am afraid i have a cyst . I dont know really but it hurts so much that i had to search on google heel pain and pretty much everything is the same (caused by cyst )