Intraosseous lipoma of the calcaneus: The non-stereotypic lesion of the bone

Abstract

Background

Intraosseous lipoma is one of the rarest benign bone tumour. They have been identified in the tibia, fíbula, metatarsals, and calcaneal. They are easily misdiagnosed as the clinical presentation is nonspecific and can mimic other ligamentous or soft tissue injury.

Case presentation

We described a 40-year-old patient with a chronic dull pain at sole of foot without significant physical findings apart from minimal swelling over the lateral ankle and local tenderness over the anterior talofibular ligament, lateral talocalcaneal joint and minimal pain at the base of left heel. MRI revealed features of suggestive of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) sprain with incidental finding of calcaneal intraosseous lipoma. Intraosseous calcaneal lipoma was treated with surgical curettage and bone graft due to the non-resolving nature of the pain despite conservative effort. Patient was symptom free and bony consolidation was visible in radiographs. No evidence of local recurrence seen and patient able to return to normal daily activities without any restrictions. Intraosseous lipoma of the calcaneus is an even rarer subset of osteolipoma and is often identified incidentally during radiologic examination, having no specific symptoms besides heel pain at the worst. Diagnosis is usually made accidentally on radiographs images. CT or MRI scans are used to confirm the fatty nature of the lipoma.

Conclusions

Intraosseous lipoma of the calcaneal is very infrequent benign tumour-like lesion that can appear with pain but can also be asymptomatic and discovered incidentally by imaging investigation. To reach the diagnosis it is usually enough to have simple x-ray and CT or MRI. It has good prognosis, usually it improves with rest and analgesia. On occasions, excision and curettage of tumour and bone grafting, or cementation can be necessary as treatment modalities in cases that failed conservative management.