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.
