Patchy marrow signal of the hindfoot in the pediatric population is a common finding, especially if bilateral and symmteric !! It's a common finding in asymptomatic active children.

This could be attributed to residual red marrow or physiologic stress from increased bone remodeling, as they are absent in children after 15 years of age.

They should be differentiated from disuse osteopenia secondary to prolonged immobilization and reflex sympathetic dystrophy. Therefore, clinical data and patient's manifestations are important for differentiation.