Stress fractures of both calcanei

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Bilateral heel pain after military recruit since three weeks.

Patient Data

Age: 20 years
Gender: Male

Linear sclerotic bands perpendicular to bone trabeculae within both calcanei reflecting stress fractures. On the right, the stress fracture is posterior. On the left, the stress fracture is more anterior reaching the upper border of the calcaneus.

Note: As part of the author's department protocol, using 1 film per projection to image both calcaneums is recommended as a cost-saving measure. This may differ depending on department protocols worldwide.

Case Discussion

Calcaneus is one of the common locations of stress fractures. History is typically recently increased activity of running or walking for distances, especially in military personnel.

Stress fractures are of two types; fatigue fracture and insufficiency fracture. The abnormal stress on normal bone results in fatigue fracture as in this case.

The calcaneus is considered one of the low-risk fracture sites for the likelihood of uncomplicated healing with conservative therapy.

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