Chronic Calcaneal Osteomyelitis Due to a Retained Coral Fragment: An Unusual Cause of Heel Pain

Eimantas Abelkis; Loes Schiphouwer

doi:10.5334/jbsr.4208

Abstract

We report a case of calcaneal osteomyelitis caused by a retained foreign body—a coral fragment. The patient presented with nonspecific heel pain 12 years after the initial injury. MRI revealed an intraosseous lesion demonstrating the ‘penumbra’ sign, consistent with chronic osteomyelitis and abscess formation. CT demonstrated a foreign body embedded within the abscess cavity. Surgical exploration confirmed the presence of a coral fragment.

Teaching point: Retained foreign bodies in bone can remain asymptomatic for many years, eventually presenting with signs of osteomyelitis.

References

Rogoff RS, Tinkle JD, Bartis DG. Unusual presentation of calcaneal osteomyelitis: Twenty‑five years after inoculation. J Am Podiatr Med Assoc. 1997;87(3):125–130. 10.7547/87507315-87-3-125.
Open DOI Search in Google Scholar Back to article
Kasalak Ö, Overbosch J, Adams HJA, et al. Diagnostic value of MRI signs in differentiating Ewing sarcoma from osteomyelitis. Acta Radiol. 2019;60(2):204–212. 10.1177/0284185118774953.
Open DOI Search in Google Scholar Back to article
Singh J, Rajakulasingam R, Saifuddin A. Langerhans cell histiocytosis of the shoulder girdle, pelvis and extremities: A review of radiographic and MRI features in 85 cases. Skeletal Radiol. 2020;49(12):1925–1937. 10.1007/s00256-020-03472-2.
Open DOI Search in Google Scholar Back to article
McGuinness B, Wilson N, Doyle AJ. The ‘penumbra sign’ on T1‑weighted MRI for differentiating musculoskeletal infection from tumour. Skeletal Radiol. 2007;36(5):417–421. 10.1007/s00256-006-0267-1.
Open DOI Search in Google Scholar Back to article
Palmanovich E, Brin YS, Laver L, Kish B, Nyska M. Pedal coral injury: A case report. Foot. 2013;23(1):50–52. 10.1016/j.foot.2012.12.005.
Open DOI Search in Google Scholar Back to article
Vidyadhara S, Rao SK. Thorn prick osteomyelitis of the foot in barefoot walkers: A report of four cases. J Orthop Surg (Hong Kong). 2006;14(2):222–224. 10.1177/230949900601400225.
Open DOI Search in Google Scholar Back to article
Surov A, Thermann F, Behrmann C, Spielmann RP, Kornhuber M. Late sequelae of retained foreign bodies after world war II missile injuries. Injury. 2012;43(9):1614–1616. 10.1016/j.injury.2011.02.021.
Open DOI Search in Google Scholar Back to article

Chronic Calcaneal Osteomyelitis Due to a Retained Coral Fragment: An Unusual Cause of Heel Pain

Abstract

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