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Primary xanthoma in foot bones is an extremely rare event. In an individual without a family history of hyperlipemia, it is even a rarer finding. One case of a xanthoma of a calcaneus is presented in an otherwise asymptomatic 19-year-old normal lipidemic female. The previous literature is reviewed. The clinical findings and treatment course are presented.
Primary lymphoma of bone in general is a very rare condition which represents approximately 3% of all primary malignant bone tumors. Of these, less than 1% originate in the foot. The following case presentation demonstrates a patient who presented with primary lymphoma of the calcaneus, diagnosed by open bone biopsy and treated with radiation therapy. The patient remained disease free for almost 3 years, at which time recurrence to the contralateral distal tibia was diagnosed again through open biopsy.
Quantitative ultrasound is the newest noninvasive method to be accepted for assessing bone mineral in adults. Heel ultrasound measurements correlate with bone density measurements by dual X-ray absorptiometry (DXA) and predict fracture risk in adults. Far less is known about the value of calcaneus ultrasound (CUS) in children. We determine spine, femoral neck, and whole-body bone mineral by DXA and heel bone mass by CUS in 125 youths (69 females, 56 males) ages 9-25 yr. CUS and DXA measurements of bone mass increased with age and pubertal development during adolescence in a parallel fashion. Among females, Tanner stage was a stronger predictor than age for all CUS and DXA measurements, and among males, pubertal stage was a stronger predictor for spine bone mineral apparent density (BMAD) and femoral bone mineral density (BMD). CUS measurements correlated moderately well with DXA measurements of the spine, femoral neck, and whole-body BMD and spine BMAD (r = 0.23-0.58, p < 0. 008). CUS warrants further study as a tool for assessing bone mineral acquisition in children.
A novel method for the development of a user-defined structural model simulating cancellous bone of the human calcaneus is described using stereolithography (SL). The digital image of a cancellous bone section was modified by skeletonisation and dilation to produce a structural model of uniform wall thickness, determined by the resolution of the stereolithography system. Six SL models were produced using the same data file. The SL models were assessed using the McCue CUBAclinical ultrasound bone densitometer. The broadband ultrasound attenuation (BUA) and velocity (VOS) values obtained were commensurate with the commercial phantom provided with the CUBAclinical system. The intra- and inter-sample variability for the six SL models were similar at 5% for BUA and 2.5% for VOS. Stereolithography offers the potential to firstly, simulate perforation and thinning of cancellous bone associated with osteoporosis, and secondly, to evaluate the dependence of ultrasonic and mechanical parameters upon cancellous bone structure.
Perichondral bone, the circumferential grooves of Ranvier and cartilage canals are features of endochondral bone development. Cartilage canals containing connective tissue and blood vessels are found in the epiphysis of long bones and in cartilaginous anlagen of small and irregular bones. The pattern of cartilage canals seems to be integral to bone development and ossification. The canals may be concerned with the nourishment of large masses of cartilage, but neither their role in the formation of ossification centres nor their interaction with the circumferential grooves of Ranvier has been established. The relationships between cartilage canals, perichondral bone and the ossification centre were studied in the calcaneus of 9 to 38-wk-old human fetuses, by use of epoxy resin embedding, three-dimensional computer reconstructions and immunhistochemistry on paraffin sections. We found that cartilage canals are regularly arranged in shells surrounding the ossification centre. Whereas most of the shell canals might be involved in the nourishment of the cartilage, the inner shell is directly connected with the perichondral ossification groove of Ranvier and with large vessels from outside. In this way the inner shell canal imports extracellular matrix, cells and vessels into the cartilage. With the so-called communicating canals it is also connected to the endochondral ossification centre to which it delivers extracellular matrix, cells and vessels. The communicating canals can be considered as inverted 'internal' ossification grooves. They seem to be responsible for both build up intramembranous osteoid and for the direction of growth and thereby for orientation of the ossication centre.
Lateral column lengthening of the calcaneus has been a powerful tool used to correct peritalar subluxation in symptomatic flat feet. The mechanical basis and limits for correction with this procedure are not well understood. A flatfoot model was created on 8 fresh-frozen cadaver feet by sectioning the deltoid ligament, talonavicular capsule, and spring ligament. Strain-gauge analysis of the long plantar ligament was performed (on 6 specimens) as the lateral column was sequentially lengthened from 4 to 12 mm in 2-mm increments. Results showed that only the lateral most one-third of the long plantar ligament measured positive strain during this procedure. The medial two-thirds of the long plantar ligament and plantar fascia decreased in tension and became fully lax during lengthening. Maximum tension in the long plantar ligament was measured after placing grafts 6 mm in thickness (P <.05). Larger grafts produced additional strain in the ligament, but were not significant. The authors conclude that grafts >6 mm have no additional corrective capacity without compromising the long plantar ligament. Either larger graft size or loss of the long plantar ligament could compromise the intrinsic stability of the lateral column of the foot. These findings may decrease the incidence of complications with this procedure, specifically lateral column pain, instability, and calcaneocuboid arthrosis.
Twenty-one patients (23 feet) treated nonsurgically for severely comminuted intraarticular fractures of the calcaneus were evaluated prospectively with a clinical scoring scale and computerized gait analysis. All patients had Sanders type III and type IV fractures. The treatment protocol consisted of no closed reduction, immobilization in removable splint, physiotherapy after edema subsided, and weightbearing after 8 weeks. All patients had a minimum follow-up of 2 years (mean, 38 months). Clinical results were good in 2 patients, fair in 3 patients, and poor in 16 patients. Gait analysis showed that patients were at high risk of gastrocnemius weakness and ankle and knee instability. These results may be useful for comparison with the results of other methods, such as open reduction and internal fixation, nonsurgical closed reduction, and arthrodesis.
Osteoid osteoma of the foot can pose particular problems in diagnosis, especially when positioned in a juxta-articular location. It can cause reactive synovitis and simulate arthritis without periostitis. An atypical presentation may delay diagnosis and thus delay treatment. Different modes of treatment have been described including medical management with nonsteroidal, antiinflammatory drugs, and open surgical resection with intralesional, marginal, or wide surgical margins. In recent years, several computed tomography-guided percutaneous techniques have been used to achieve ablation of the nidus with minimal tissue invasion. We report a case of a 39-year-old man with an 8-month history of persistent foot pain who underwent percutaneous radiofrequency ablation of an osteoid osteoma involving the calcaneus. The patient related an immediate relief of pain and had no recurrence of symptoms or the lesion at 3-year follow-up.
Osteomyelitis of the os calcis challenges the reconstructive surgeon. We present the case of a patient in which massive medullary osteomyelitis of the calcaneus was treated with a technique that preserves the bone shape. The medullary cavity of the bone was first emptied, preserving the cortical shell. Then a free muscle flap was used to fill up the dead space. Three months later autologous bone grafts were packed into the cavity. Full weight-bearing was commenced 4 months after this procedure. In the latest follow-up, 2 1/2 years, the patient has had no recurrence or difficulty with walking.
INTRODUCTION: Mechanical and static stress as well as rheumatic diseases may cause retrocalcanear bursitis. Anatomic variants of the calcaneus predispose to this bursitis. CASE: A 51-year-old woman being afraid of operation waited 2 years before undergoing bursectomy al her right heel. For this reason the increase of calcanear bone loss and its stabilisation by sclerosis is well documented in X-rays and MR images. A secondary synovialitis of the peroneal tendons decided completely after bursectomy. No signs of rheumatic disease were found. CONCLUSION: The radiological, clinical and hisiological findings in long-persisting bursitis are often simular to those found in patients with rheumatic disease. Normal laboratory findings do not preclude an early stadium of rheumatic disease. For this reason, these patients had to be instructed to return if they develop further synovialitis to verify the diagnosis and to avoid delayed therapy.
A stressfracture of the calcaneus after aerobic-gymnastic was observed. In comparance with stressfractures of different localisation there is only little of periostal callus. The leading radiological is spongiosasclerosis.
Eight lesions in the calcaneus have been treated surgically between 1955 and 1979; of these, six were due to tuberculosis, one to chronic osteomyelitis and the other was a cyst. The diagnosis was confirmed bacteriologically and histologically. In all cases (average age 49.1 years) the human bacillus was proved to be the cause of an haematogenous infection. The lesion was confined to the posterior part of the bone and there was no extension into the calcaneo-navicular joint. Two patients presented with fistulae. The interval from the onset of symptoms to confirmation of the diagnosis averaged 9.1 months. Three patients had previously been treated for tuberculosis (lung, pleura, kidney) and another patient, who had a simultaneous tuberculous infection of a sternoclavicular joint had suffered from tuberculosis cervical lymphadenitis at the age of nine years.U
Intra-articular fractures of the calcaneus typically occur in individuals working on ladders, scaffolding or roofs. Male individuals in their productive age are most at risk. The functional problems that frequently persist are a well-known risk since they may obstruct a safe resumption of the former job. According to the data of the National Institute for Sickness and Invalidity Insurance the number of calcaneal fractures in Belgium have stabilised over the last ten years. These figures indicate the necessity for a better prevention policy. Scientific literature about the problem of impairment and disability in these cases is rare and lacks uniformity. A retrospective study was therefore performed on 65 private insurance compensation patients who were treated for intra-articular calcaneal fractures. The mean period of work incapacity was 260.5 days and the mean percentage of impairment was 12.3%. A large group (86.2%) were able to resume their former activities including the height workers. More than half of the patients (57%) needed a supportive device. Working at heights and falls from a height were a significant risk factor for long-term work incapacity. The figures are compared with the limited literature and further discussed.
It has been experimentally demonstrated that for the measurement of broadband ultrasound attenuation (BUA) at the human calcaneus the cortical end-plate creates a measurement artefact of the order of 7 dB MHz(-1). It has been suggested that the origin of this artefact may be a phase cancellation of the ultrasound pulse resulting from inconsistencies in propagation time across the ultrasound beam. Experimental and computer simulations were performed on samples of varying degrees of curvature and hence varying propagation times across the ultrasound beam. The experimental simulation incorporated Perspex samples of 35, 50 and 75 mm radius. The computer simulation was implemented using Matlab and Simulink, with the propagation time represented by a transport delay. The wavelet-based simulation incorporated a digitized transmitted ultrasound pulse derived from the experimental simulation. The experimental and computer-derived frequency spectra for the varying radii samples were comparable, demonstrating, firstly, that there is a significant dependence of measured BUA upon radius of curvature and, secondly, that the response in measured BUA to radius of curvature is similar in magnitude and trend for both experimental and computer simulations. The current study suggests that the BUA artefact observed in vitro corresponds to a radius of approximately 58 mm. Although the radius of curvature was not recorded in the original in vitro study, this value appears to be reasonable. This study indicates that the assumptions within the computer simulation were manifested within the experimental validation, and, hence, the observed BUA measurement artefact is related to the presence of the calcaneal cortical end-plate and is due to phase cancellation of the propagating ultrasound pulse.
The mineral density of the calcaneus was measured in representative samples of men, aged 31-35, 51-55, and 71-75 years, utilizing a 125I-gamma-ray attenuation method. There was a gradual decrease in bone mineral density from the youngest to the oldest age group. Those men who participated in regular physical activity or who were non-smokers showed higher values for bone mineral density when compared to sedentary men or smokers, respectively. Furthermore, bone mineral density correlated positively with physical performance capacity and negatively with the prevalence of chronic diseases.
BACKGROUND: Quantitative ultrasound measurement (broadband ultrasound attenuation and speed of sound) is emerging as an alternative to photon absorptiometry techniques in the assessment of osteoporosis. OBJECTIVE: To discuss briefly the fundamentals of ultrasound measurement of bone and critically review recent studies on the role of ultrasound in bone quality assessment and hip fracture prediction. CONCLUSIONS: The relationships between ultrasound and bone mineral density are too weak to allow accurate prediction of bone density at any skeletal site--including the hip--from an ultrasound measurement at the calcaneus. However, in vitro evidence indicates that ultrasound provides structural information in addition to density. In line with these in vitro data, recent prospective studies have shown that ultrasound predicts hip fractures strongly and independently of densitometry in older women.
A bone bruise to both calcanei after axial overloading is reported. Because radiographs were normal and weightbearing was not possible, magnetic resonance imaging was performed and showed characteristic findings for a bone bruise of the calcaneus more extended on the left side than the right side. Resolution of pain was within the first 2 weeks after trauma on the right side, whereas partial weightbearing was necessary for 4 months on the left side. Six months after trauma, complete resolution of magnetic resonance signal changes was evident. Bone bruises should be considered when radiographs are normal. Because bone bruises pose a potential risk for chondrolysis and stress fracture, mobilization and weightbearing should be increased gradually.
RATIONALE AND OBJECTIVES: The purpose of this study was to compare trabecular bone structure parameters assessed with high-resolution magnetic resonance imaging (HR-MRI) with those determined in specimen sections. METHODS: High-resolution MR images were obtained for 30 calcaneus specimens with a three-dimensional, T1-weighted spin-echo sequence (spatial in-plane resolution 0.195 mm, slice thicknesses of 0.3 and 0.9 mm). Thirty-eight sections were obtained from the specimens, and contact radiography was performed. In the corresponding sections, structural parameters analogous to bone histomorphometry were determined. RESULTS: Significant correlations between MRI-derived structural parameters and those derived from macro pathological sections were found: r values of up to 0.75 were obtained (P < 0.01). The highest correlations were found for apparent bone volume/total volume and trabecular thickness. Image thresholding techniques showed a significant impact on these correlations (P < 0.01). The thinner MR sections were less susceptible to the different thresholding algorithms. CONCLUSIONS: Trabecular bone structure depicted by HR-MR images is significantly correlated with that shown in macro sections (P < 0.01); however, a number of limitations have to be considered, including the substantial impact of thresholding techniques and slice thickness.