Calcaneal stress fracture diagnosed by MRI

Abstract

Abstract This case report demonstrates a paediatric calcaneal stress fracture not seen on traditional radiograph but diagnosed by MRI. A young athlete presented at age 15 with heel pain and no trauma. Calcaneal stress fractures in children are rare and could be underdiagnosed since radiographs are often false negative especially in the early stages. Therefore, calcaneal stress fractures with a normal radiograph could be misclassified as Server's injury. The treatment strategy for a calcaneal stress fracture is more aggressive than for Server's injury and therefore distinction towards a stress fracture is important to choose the optimal treatment. Consequently, when a child presents with acute limp, refusal to walk and/or heel pain, with no evident trauma and negative radiographs further investigation is needed. We propose performing a bone scintigraphy or MRI to avoid overlooking stress fractures of the calcaneus and misclassify these fractures as Sever's injury.