Published online Sep 18, 2019. doi: 10.5312/wjo.v10.i9.339
Peer-review started: March 8, 2019
First decision: April 16, 2019
Revised: May 15, 2019
Accepted: August 12, 2019
Article in press: August 13, 2019
Published online: September 18, 2019
Heel pain is a common orthopaedic complaint, and if left untreated can be a source of chronic morbidity. Accurate diagnosis can be challenging, owing to the complex anatomy and multiple pain generators present in the foot. We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.
A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain. He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverskiöld test. He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention. Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus. The decision was made for excision of the osteochondroma, and the patient has been pain-free since.
Osteochondromas are rarely symptomatic in skeletally mature patients. While most are benign with a very low risk of malignant transformation, surgical excision can yield excellent results and significant pain relief in symptomatic patients.
Core tip: Heel pain is a common orthopaedic complaint. If not treated correctly, it can lead to chronic morbidity and disability. Plantar fasciitis is diagnosed clinically. Advanced imaging is rarely required and used to exclude underlying sinister pathology. Osteochondromas of the calcaneum are rare. In symptomatic patients, excision can improve outcomes.