Intraosseous Lipoma of the calcaneus: A rare and often missed cause of chronic heel pain
Ishwar Bohra, Lester Pereira
Intraosseous Lipoma is one of the rarest benign bone tumours formed by mature adipose tissue. The incidence has been reported to be less than 0.1% of all primary bone tumors. Cases have been reported in the tibia, fibula, metatarsals and calcaneus. The differential diagnosis of an intraosseous lipoma in the calcaneus include plantar fasciitis, retrocalcaneal bursitis, gout, aneurysmal bone cyst, unicameral bone cyst, osteoblastoma, stress fracture etc. Herein, we reported a 58 year old female who presented with chronic right heel pain. She was being treated conservatively with no relief in symptoms. On initial evaluation, calcaneal X-rays revealed an expansile unicameral lytic lesion. The diagnosis was confirmed as calcaneal lipoma on CT scan and magnetic resonance imaging and further on biopsy. The patient underwent curettage and bone grafting with synthetic bone graft substitute under spinal anaesthesia. On a 3-month postoperative follow-up, the patient returned to full ambulation. 6-months postoperative radiographs demonstrated satisfactory remodelling and consolidation of the graft. The purpose of this article is three fold: a) Firstly, to emphasise the possibility of bony lesions like calcaneal lipomas as a rare cause of chronic heel pain as opposed to the usual suspects which are mostly of soft tissue origin. b) Secondly, how including plain radiographs in the initial evaluation of these patients could easily diminish missed and delayed diagnosis of these lesions. c) And thirdly, to discuss the treatment rationale based on symptoms, site and size of the lesion.