Insufficiency Fracture of the Body of the Calcaneus in Elderly Patients with Osteoporosis

Abstract

Two cases of insufficiency fracture of the body of the calcaneus are presented to show its clinical presentation and diagnosis. It often is overlooked as a cause of pain in the ankle region. Both patients were elderly women with pain developing at the lateral aspect of the hindfoot in the absence of significant trauma. Physical examination was significant for marked tenderness at the superolateral aspect of the calcaneus. These clinical features suggested the diagnosis, which was confirmed by radionuclide bone scan and magnetic resonance imaging. Magnetic resonance imaging was the diagnostic tool in both cases, after abnormal bone scans and normal plain radiographs. Radiologic alterations were not seen for up to 2 months after the onset of pain. Treatment consisted of rest and protected weightbearing for 8 weeks, with complete resolution of symptoms in both patients. An insufficiency fracture of the body of the calcaneus should be considered in a differential diagnosis of elderly patients with osteoporosis with spontaneous pain in the ankle region.

Calcaneal Stress Fracture: An Adverse Event Following Total Hip and Total Knee Arthroplasty

“…It is unknown why all thirteen patients in both the present report and the reports by Ito et al 24 and by Alonso-Bartolome 25 were female. In part, it may be because osteoporosis occurs more frequently in females, and nearly 80% of the candidates for joint replacement in our hospital are female.…”

“…Calcaneal insufficiency fractures occur in bones having less than normal elastic resistance to compression and stretching. They occur in elderly individuals with osteoporosis without any antecedent trauma or overuse 24,25 and are not commonly recognized [24][25][26][27][28][29][30] . The cases of two patients reported by Ito et al 24 , the cases of six patients reported by Alonso-Bartolome et al 25 , and the five patients in the present report are the best examples in the literature.…”

“…Perhaps these insufficiency fractures following joint replacement surgery are more common than appreciated. They can be easily overlooked unless suspected, and both Ito et al 24 and Alonso-Bartolome et al 25 stated that often they might be underrecognized and mistaken for other conditions. All five stress fractures in this series occurred on the same side as the arthroplasty.…”

Medial Malleolar Insufficiency Fracture of the Ankle in an Elderly Patient with Osteoporosis

“…In this case, the clinical signs were mild pain in the medial aspect of the ankle, which was confirmed by an MRI. [11,12] The treatment of an insufficiency fracture depends on the clinical presentation and whether the fracture is complete or incomplete. Treatment options are conservative treatment, a splint or a cast, and an operation such as internal fixation.…”

Proceedings of the Foot and Ankle meeting, Leiden, 25.03.2011

“…1). Therefore, it gives a clue to accompanying ligament lesions and grades the lesion at the distal tibiofibular and ankle joint as being stable or unstable (2)(3)(4)(5)(6)(7). In case of supination-adduction trauma (Weber A type), the presence of an oblique (push off) fracture of the medial malleolus includes a major lateral lesion.…”