Insufficiency fracture of the body of the calcaneus in elderly patients with osteoporosis - A report of two cases

Two cases of insufficiency fracture of the body of the calcaneus are presented to show its clinical presentation and diagnosis. It often is overlooked as a cause of pain in the ankle region. Both patients were elderly women with pain developing at the lateral aspect of the hindfoot in the absence of significant trauma. Physical examination was significant for marked tenderness at the superolateral aspect of the calcaneus. These clinical features suggested the diagnosis, which was confirmed by radionuclide bone scan and magnetic resonance imaging. Magnetic resonance imaging was the diagnostic tool in both cases, after abnormal bone scans and normal plain radiographs. Radiologic alterations were not seen for up to 2 months after the onset of pain. Treatment consisted of rest and protected weightbearing for 8 weeks, with complete resolution of symptoms in both patients. An insufficiency fracture of the body of the calcaneus should be considered in a differential diagnosis of elderly patients with osteoporosis with spontaneous pain in the ankle region.