A calcaneal osteochondroma with recurrence in a skeletally mature patient: a case report

Solitary Osteochondromas of the Metatarsal and Cuneiform, in an Adolescent

Introduction

Solitary osteochondromas are extremely rare in the bones of the foot. In the growing skeleton, few cases affecting the metatarsals and the talus have been reported. At present, there have been no reports of osteochondromas affecting the cuneiforms.

Case Report

We report the case of a 13-year-old male patient. He presented with marked prominences in the plantar surface of his left foot and pain while participating in sporting activities. Radiological examination with X-rays, computed tomography (CT) scan, and magnetic resonance imaging revealed two solitary osteochondromas growing from the medial cuneiform and the head of the 1st metatarsal. The patient was treated surgically by excision of the osteochondromas. Histological examination confirmed the diagnosis of osteochondromas. He had an uneventful recovery and returned to his sporting activities.

Conclusion

Solitary osteochondroma can present in the cuneiform and metatarsal of a growing adolescent. CT scan is useful for the accurate diagnosis and surgical removal of the tumor.

Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain - A case report and literature review

BACKGROUND

Heel pain is a common orthopaedic complaint, and if left untreated can be a source of chronic morbidity. Accurate diagnosis can be challenging, owing to the complex anatomy and multiple pain generators present in the foot. We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.

CASE SUMMARY

A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain. He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverskiöld test. He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention. Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus. The decision was made for excision of the osteochondroma, and the patient has been pain-free since.

CONCLUSION

Osteochondromas are rarely symptomatic in skeletally mature patients. While most are benign with a very low risk of malignant transformation, surgical excision can yield excellent results and significant pain relief in symptomatic patients.

Primary tumours of the calcaneus

The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.