CT Diagnosis of a Plantar Calcaneal Enthesophyte Fracture Following Initially Negative Radiographs

Fracture of a plantar calcaneal enthesophyte is an uncommon injury that may be difficult to detect on radiographs.A 50-year-old woman presented with sharply localized plantar heel pain after direct axial trauma to the right heel.Initial right-foot radiographs and subsequent contralateral comparison radiographs were interpreted as negative for acute fracture.Persistent focal pain prompted repeat evaluation approximately 24 hours later.Noncontrast computed tomography demonstrated an isolated minimally displaced fracture confined to the plantar calcaneal enthesophyte, without extension into the calcaneal tuberosity, calcaneal body, or adjacent joints.Orthopedic consultation recommended nonoperative management with short-term immobilization, analgesia, and protected weight-bearing.This case demonstrates that a plantar enthesophyte fracture may remain occult on initial radiographs despite focal post-traumatic symptoms.Persistent, well-localized plantar heel pain after negative radiographs should prompt consideration of computed tomography to establish the diagnosis and exclude more extensive calcaneal injury.