A 25-year-old professional football player presented for a pre-signing medical assessment. As part of this assessment he had an x-ray of both ankles, knees and hips. The player had no complaints whatsoever with their right ankle or foot and did not have a history of an injury of the ankle.
The lateral x-ray of the right ankle shows a lucency in the calcaneal bone. A sagittal MRI image shows high signal intensity on T2-weighted images. The peripheral rim has very low signal intensity on MRI.
This player was completely asymptomatic and did not receive any treatment. The finding did not influence the outcome of his medical assessment and he went on to sign a professional contract. He has not experienced any further symptoms since.
Simple (solitary or unicameral) bone cysts of the calcaneus are fluid-filled cavities located within a bone. They are benign lesions that are well described in the literature. Bone cysts can occur in any bone but are most common in the metaphyseal region of the proximal humerus or femur. The calcaneal location is very rare and represents between 2-14% of simple bone cysts.
The pathogenesis of calcaneal cysts is not clear and probably differs from that in the long bones because calcaneal cysts are not adjacent to growth plates. They are usually discovered incidentally or associated with generally moderate pain that may relate to microfractures. Major pathologic fractures due to CBCs are rare, unlike cysts of the long bones. Cysts that are pain free are generally benign and do not need treatment. When the cyst causes pain or is located close to the cortical bone, surgery is indicated.
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