Calcaneus secundarius – a relevant differential diagnosis in ankle pain: a case report and review of the literature

Daniel Krapf, Sebastian Krapf, Christian Wyss

Accessory ossicles of the foot are a common finding. Although mostly asymptomatic, they can gain clinical relevance by trauma or stress on the complex biomechanical system of the foot. There are few reports on the entity of symptomatic calcaneus secundarius. Furthermore, the current literature does not address the need for awareness of calcaneus secundarius as a differential diagnosis in cases of persistent posttraumatic ankle pain. We present the case of a 51-year-old Indo-European man with a medical history of persistent load-dependent ankle pain over 3 decades. At presentation after an acute ankle sprain, we diagnosed a traumatized calcaneus secundarius. Surgical excision led to a complete recovery. More than 1 year postoperative he is still asymptomatic. With the presented case and review of the literature we demonstrate the clinical relevance of calcaneus secundarius. Depending on size and alignment, calcaneus secundarius can alter the biomechanics in the subtalar region generating pain at the ankle. If a patient has persistent sinus tarsi syndrome, a painful limited subtalar range of motion or repetitive ankle sprains, then calcaneus secundarius should be considered in differential diagnosis. Likewise when a fracture of the anterior process of the calcaneus or a calcaneonavicular coalition is suspected, calcaneus secundarius should be considered a possible diagnosis by all clinicians confronted with foot and ankle pain.