Insufficiency fracture of the calcaneum: Sonographic findings

Abstract

We present a case of insufficiency fracture (IF) of the calcaneum diagnosed by sonography (US). An 83-year-old woman consulted because of pain and swelling of the left heel without history of trauma. Standard radiographs showed osteoporosis without fracture. US revealed thickening of the calcaneal periosteum associated with edema of the adjacent soft tissues. Color Doppler imaging showed marked increased vascularity of the periosteum. US changes, together with the clinical and radiographic findings, were consistent with an IF of the calcaneum that was confirmed by MRI. The patient was treated successfully by conservative treatment. In the proper clinical setting, US can suggest the diagnosis of IF of the calcaneum.

Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report

“…Hyperechogenicity of the surrounding soft tissue which indicates soft tissue edema and inflammatory reaction 12,20 ;…”

Bilateral stress fracture of the tibia diagnosed by ultrasound. A case report

“…This sign can be seen only in small bone such as the metatarsals [3] thickening of the periosteum which appears as a hypoechoic band overlying the hyperechoic bone cortex [4] Increased periosteal colour Doppler flow related to local hyperaemia [5] hyperechogenicity of the surrounding soft tissue which indicates soft tissue oedema and inflammatory reaction. Doppler abnormalities and hyperechogenicity of the local soft tissue are most important for establishing an early diagnosis [6,12,15].…”

“…Although they can affect the upper extremity, FF mostly involve the lower extremity with prevalence for the tibia, the neck of the femur, the metatarsal bones and the calcaneus [1,2,6,7]. Patients present with local pain typically accentuated by activity and diminished by rest.…”

“…In the past few years, various authors have reported ultrasound (US) as an inexpensive, non-invasive and ready modality with high sensitivity for the investigation of SF of the metatarsal [10,11]. Reports of SF affecting other bones then metatarsals diagnosed by US are rare [6]. Nevertheless US can be useful in diagnosing SF if the examination is accurately performed by an expenciered sonologist with a high degree of clinical suspicion.…”

Proceedings of the Foot and Ankle meeting, Leiden, 25.03.2011

“…Ultrasound may give an indication that fracture is present by hyperaemia and thickening of the periosteum, is however non specific (13). Nuclear imaging has a high sensitivity but low specificity for this type of injury.…”