Calcaneal stress fracture diagnosed by MRI

• Published in: Journal of pediatric surgery case reports 2021-03, Vol.66, p.101795, Article 101795
• Main Authors: Engbjerg, Jacob Schade, Gottliebsen, Martin, Thorninger, Rikke
• Format: Article
• Language: English
• Subjects: Calcaneal stress fractures in children; MRI; Sever's injury
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2021.101795

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. •Calcaneal stress fractures in children are rare but seem underdiagnosed.•Radiographs are often negative in the early stages.•Calcaneal stress fractures can be misclassified as Sever's injury when radiographs are negative.•Calcaneal stress fracture can by diagnosed by MRI or bone scintigraphy in the early stages.•Consider an MRI when a child presents with heel pain and no evidient trauma not to overlook calcaneal stress fractures.