# Delayed Diagnosis of Calcaneal Stress Fracture: A Case Report

## TL;DR

A 57-year-old woman's heel pain was initially misdiagnosed but later found to be a calcaneal stress fracture requiring MRI for accurate detection.

## Contribution

The paper proposes a management pathway to avoid delayed diagnosis of calcaneal stress fractures.

## Key findings

- Initial X-rays failed to detect the calcaneal stress fracture in the patient.
- MRI confirmed the stress fracture after persistent symptoms.
- Conservative treatment improved symptoms following diagnosis.

## Abstract

The calcaneus is a key component of the hindfoot, susceptible to stress fractures due to its role in bearing significant axial loads. These fractures often result from repetitive forces, yet their diagnosis can be challenging due to overlapping symptoms with more common causes of heel pain. Early recognition of calcaneal stress fractures is essential to prevent complications like non-union and the need for surgical intervention. Given that initial radiographs may appear normal, advanced imaging techniques such as magnetic resonance imaging (MRI) should be considered when clinical suspicion remains high.

Here, we report a 57-year-old woman who presented with acute left heel pain following a minor trauma. Initial X-rays showed no acute bony injury, leading to a soft tissue injury diagnosis. However, persistent pain prompted further evaluation, revealing a stress fracture of the left calcaneum upon MRI. Conservative management with non-weight-bearing and an ankle boot led to symptomatic improvement.

As calcaneal stress fractures often elude initial diagnosis due to their early radiographic normalcy, this report postulates a management pathway for patients presenting with heel pain to avoid a delayed diagnosis.